Medical student program to learn from families experiencing developmental disabilities.

Patients and families experiencing developmental disabilities (DDs) may lack trust in physicians due to negative experiences in healthcare. DDs include conditions impairing physical, learning, language, or behavior areas, beginning during the developmental period and impacting daily functioning ('Developmental Disabilities'). Medical students generally do not receive standard training to effectively communicate with and diagnose patients with DDs. ARIE is a program for medical students to meet and learn from these patients and their families. Students learn about these families' experiences during home visits, guided by standardized interview questions and surveys about families' trust in physicians. Families did not appear to strongly trust physicians, with no significant changes after the program. Families shared they experienced physicians' lack of empathy and knowledge when caring for patients with DDs. Families wanted future physicians to be empathetic and informed when treating children with disabilities. Students reported increased comfort and confidence in interacting with patients with DDs as well as their families after completing the training program. Implementing a service-learning model focused on DDs at other medical schools, incorporating training with communication techniques and home visits, can increase students' confidence and experiences when engaging with patients with DDs and their families.

Antiphospholipid Syndrome in a Patient With Autosomal Dominant Polycystic Kidney Disease: The Surface of the Moon.

Antiphospholipid syndrome (APS) is a rare coagulopathic disorder diagnosed with a combination of clinical/imaging findings with specific antibody titer elevations over a period of 12 weeks. The following case report will discuss the unusual and challenging hospital course of a patient with extensive autosomal dominant polycystic kidney disease (ADPKD) being treated for a multi-drug resistant urinary tract infection (UTI). The patient later developed multiple deep vein thrombosis (DVT) and was found to have antiphospholipid syndrome. Warfarin, the anticoagulant of choice for antiphospholipid syndrome, has a higher likelihood of intracerebral hemorrhage than direct oral anticoagulants. This is particularly challenging since patients with autosomal dominant polycystic kidney disease have a higher propensity to develop intracranial aneurysms (ICA).

Naturalistic Usability Testing of Inpatient Medication Reconciliation Software.

Medication history errors are common at admission, but can be mitigated through the implementation of medication reconciliation (MR). We designed multi-media software to assist clinicians with collection of an admission history. This manuscript describes a naturalistic usability study conducted on the hospital wards. Our goals were to 1) estimate the impact of our workflow upon departmental productivity and 2) determine the ability of our software to detect discrepancies. We furnished clinical pharmacists with our application on a tablet PC and asked them to collect a bedside history. We used 1) time-motion analysis to estimate cycle-time and 2) chart reviews to estimate error detection rates. Our intervention detected an average of 7.7 discrepancies per admission (11.7 per pharmacy-shift). A panel rated 67% of these discrepancies as 'high' or 'very high' risk. The cycle-time per admission was slightly longer than usual care processes (20.5 min vs. 17.9 min), but included a bedside interview. In general, pharmacists agreed that the technology improved the completeness and accuracy of a medication history. However, workflow leveling strategies are important to implementing a durable process. In conclusion, a pharmacist-mediated, patient-centered technology holds promise for improving the quality of MR and overall clinical performance.

Design of admission medication reconciliation technology: a human factors approach to requirements and prototyping.

OBJECTIVE: Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design. BACKGROUND: Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission. METHODS: We completed an ethnography and time and motion analysis of pharmacists in order to illustrate the processes used to reconcile medications. We then used the requirements to design prototype multimedia software for collecting a bedside medication history. We observed how pharmacists incorporated the technology into their physical environment and documented usability issues. RESULTS: Admissions occurred in three phases: (1) list compilation, (2) order processing, and (3) team coordination. Current medication reconciliation processes at the hospital average 19 minutes to complete and do not include a bedside interview. Use of our technology during a bedside interview required an average of 29 minutes. The software represents a viable proof-of-concept to automate parts of history collection and enhance patient communication. However, we discovered several usability issues that require attention. CONCLUSIONS: We designed a patient-centered technology to enhance how clinicians collect a patient's medication history. By using multiple human factors methods, our research team identified system themes and design constraints that influence the quality of the medication reconciliation process and implementation effectiveness of new technology. KEYWORDS: Evidence-based design, human factors, patient-centered care, safety, technology.