Medication adherence: staying within the boundaries of safety

Abstract

An important domain of patient safety is the management of medications in home and community settings by patients and their caregiving network. This study applied human factors/ergonomics theories and methods to data about medication adherence collected from 61 patients with heart failure accompanied by 31 informal caregivers living in the US. Seventy non-adherence events were identified, described, and analysed for performance shaping factors. Half were classified as errors and half as violations. Performance shaping factors included elements of the person or team (e.g. patient limitations), task (e.g. complexity), tools and technologies (e.g. tool quality) and organisational, physical, and social context (e.g. resources, support, social influence). Study findings resulted in a dynamic systems model of medication safety applicable to patient medication adherence and the medication management process. Findings and the resulting model offer implications for future research on medication adherence, medication safety interventions, and resilience in home and community settings.

Practitioner Summary: We describe situational and habitual errors and violations in medication use among older patients and their family members. Multiple factors pushed performance towards risk and harm. These factors can be the target for redesign or various forms of support, such as education, changes to the plan of care, and technology design.

Keywords:

• Patient safety
• resilience
• medication adherence
• chronic disease
• human factors in healthcare

Acknowledgements

We would like to thank the participants of this study who graciously shared their time, knowledge, and homes with us. We also thank the cardiologists, nurse practitioners, nurses and medical assistants who allowed us to observe their clinics. Thank you to Amanda McDougald Scott and Courtney Thomas who performed tireless data collection, sometimes under less than ideal conditions. We thank the reviewers for their thoughtful comments which have strengthened the paper.