Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.

Intergroup relations in action: questions asked about lesbian, gay and bisexual issues in diversity training

This paper focuses on the questions which heterosexual trainees ask about lesbian, gay and bisexual (LGB) experience within diversity training about LGB issues. Drawing on a data corpus of 162 questions asked by trainees in 13 tape-recorded training sessions, questions were coded into six categories: (1) general understanding questions; (2) questions about the trainer's life, experience and practices; (3) professional practice questions; (4) questions about lesbian and gay related legislation, policies and procedures; (5) questions about specific people and projects and (6) questions about the meanings, derivations and correct use of terms and symbols. Real questions are compared with the decontexualized questions (and answers to them) that are provided in training manuals and it is demonstrated that these questions differ markedly from how questions actually get asked and how they actually get answered. Recommendations are provided for improving training and the argument made for turning towards analyses of the real world in action, especially when considering intergroup relations. Copyright © 2008 John Wiley & Sons, Ltd.

An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital

Aims: To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm. Method: A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses. Results: Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases. Conclusions: This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.

'They cooperate with us, so they are like me': perceived intergroup relationship moderates projection from self to outgroups

Whereas projection of self-attributes to ingroups is ubiquitous, projection of self-attributes to outgroups (outgroup projection) is an elusive phenomenon. Two experiments examined the moderating effect of perceived intergroup relationship on outgroup projection and explored underlying mechanisms. Perceived cooperation versus competition between ingroup and outgroup was manipulated using fictitious (Experiment 1) or natural groups (Experiment 2). In both experiments, participants judged the outgroup as more similar to the self in the cooperation condition than in the competition condition. This effect was independent of recategorization, perceived intergroup similarity, and ingroup-to-outgroup projection. These studies demonstrate the very existence of outgroup projection and extend previous work on moderators of projection from self to groups.

Boundary spanners' identification, intergroup contact and effective intergroup relations

We examined the relationship between group boundary spanners’ work group identification and effective (i.e., harmonious and productive) intergroup relations in 53 work groups in five health care organizations. The data suggest this relationship was moderated by boundary spanners’ levels of organizational identification, thus supporting a dual identity model. Limited support was found for the moderating effect of intergroup contact. Finally, if boundary spanners displayed frequent intergroup contact and identified highly with their organization, group identification was most strongly related to effective intergroup relations.

Intergroup conflict and intergroup effectiveness in organizations:theory and scale development

Many see the absence of conflict between groups as indicative of effective intergroup relations. Others consider its management a suitable effectiveness criterion. In this article we demarcate a different approach and propose that these views are deficient in describing effective intergroup relations. The article theorizes alternative criteria of intergroup effectiveness rooted in team representatives' subjective value judgements and assesses the psychometric characteristics of a short measure based on these criteria. Results on empirical validity suggest the measure to be a potential alternative outcome of organizational conflict. Implications for both the study of intergroup relations and conflict theory are discussed. © 2005 Psychology Press Ltd.

Selling, resistance and reconciliation:a critical discursive approach to subsidiary role evolution in MNEs

Studies of political dynamics between multinational enterprise (MNE) parents and subsidiaries during subsidiary role evolution have focused largely on control and resistance. This paper adopts a critical discursive approach to enable an exploration of subtle dynamics in the way that both headquarters and subsidiaries subjectively reconstruct their independent-interdependent relationships with each other during change. We draw from a real-time qualitative study of a revealing case of charter change in an important European subsidiary of an MNE attempting to build closer integration across European country operations. Our results illustrate the role of three discourses – selling, resistance and reconciliation – in the reconstruction of the subsidiary–parent relationship. From this analysis we develop a process framework that elucidates the important role of these three discourses in the reconstruction of subsidiary roles, showing how resistance is not simply subversive but an important part of integration. Our findings contribute to a better understanding of the micro-level political dynamics in subsidiary role evolution, and of how voice is exercised in MNEs. This study also provides a rare example of discourse-based analysis in an MNE context, advancing our knowledge of how discursive methods can help to advance international business research more generally.

Intergroup conflict in organisations:predictors and relationships with team working effectiveness

This thesis begins with a review of the conflict literature. It continues with an illustration of the nature of intergroup conflict between British health care teams, by presenting results from an interview study using the critical incident technique. Within the theory testing part, drawing upon a sample of 53 British health care teams from five organisations, an empirical test of both intergroup contact and social identity theory is provided. In a next step, a measure of intergroup effectiveness, the effectiveness with which dyads of groups perform on collaborative tasks, is developed. Finally, the moderating role of both resource interdependence and group boundary spanners’ negotiation style for the relationship between intergroup competition and longitudinal change in group and intergroup effectiveness is examined.

The relationship between intergroup competition and longitudinal change in group effectiveness

Presentation of an abstract

Intergroup leadership in organizations:leading across group and organizational boundaries

Intergroup leadership-leadership of collaborative performance of different organizational groups or organizations-is associated with unique intergroup challenges that are not addressed by traditional leadership theories. To address this lacuna, we describe a theory of intergroup leadership. Firmly grounded in research on social identity and intergroup relations, the theory proposes that effective intergroup performance rests on the leader's ability to construct an intergroup relational identity. We describe key leadership actions to establish such an identity. © 2012 Academy of Management Review.

Medication reconciliation by a pharmacy technician in a mental health assessment unit

Background: Medication discrepancies are common when patients cross organisational boundaries. However, little is known about the frequency of discrepancies within mental health and the efficacy of interventions to reduce discrepancies. Objective: To evaluate the impact of a pharmacy-led reconciliation service on medication discrepancies on admissions to a secondary care mental health trust. Setting: In-patient mental health services. Methods: Prospective evaluation of pharmacy technician led medication reconciliation for admissions to a UK Mental Health NHS Trust. From March to June 2012 information on any unintentional discrepancies (dose, frequency and name of medication); patient demographics; and type and cause of the discrepancy was collected. The potential for harm was assessed based on two scenarios; the discrepancy was continued into primary care, and the discrepancy was corrected during admission. Logistic regression identified factors associated with discrepancies. Main outcome measure: Mean number of discrepancies per admission corrected by the pharmacy technician. Results Unintentional medication discrepancies occurred in 212 of 377 admissions (56.2 %). Discrepancies involving 569 medicines (mean 1.5 medicines per admission) were corrected. The most common discrepancy was omission (n = 464). Severity was assessed for 114 discrepancies. If the discrepancy was corrected within 16 days the potential harm was minor in 71 (62.3 %) cases and moderate in 43 (37.7 %) cases whereas if the discrepancy was not corrected the potential harm was minor in 27 (23.7 %) cases and moderate in 87 (76.3 %) cases. Discrepancies were associated with both age and number of medications; the stronger association was age. Conclusions: Medication discrepancies are common within mental health services with potentially significant consequences for patients. Trained pharmacy technicians are able to reduce the frequency of discrepancies, improving safety. © 2013 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie.

Counter-stereotypes reduce emotional intergroup bias by eliciting surprise in the face of unexpected category combinations

In three experiments we investigated the impact that exposure to counter-stereotypes has on emotional reactions to outgroups. In Experiment 1, thinking about gender counter-stereotypes attenuated stereotyped emotions toward females and males. In Experiment 2, an immigrant counterstereotype attenuated stereotyped emotions toward this outgroup and reduced dehumanization tendencies. Experiment 3 replicated these results using an alternative measure of humanization. In both Experiments 2 and 3 sequential meditational analysis revealed that counter-stereotypes produced feelings of surprise which, in turn, elicited a cognitive process of expectancy violation which resulted in attenuated stereotyped emotions and an enhanced use of uniquely human characteristics to describe the outgroup. The findings extend research supporting the usefulness of counter-stereotype exposure for reducing prejudice and highlight its positive impact on intergroup emotions.

Comparing direct and imagined intergroup contact among children:effects on outgroup stereotypes and helping intentions

We conducted an experimental intervention aimed at comparing the effectiveness of direct and imagined intergroup contact. Italian elementary school children took part in a three-week intervention with dependent variables assessed one week after the last intervention session. Results revealed that direct and imagined intergroup contact, compared to control conditions of direct and imagined intragroup contact, had an additive impact when it came to reducing negative stereotypes of immigrants and fostering future helping intentions toward this group. The theoretical and practical implications of the findings are discussed.

Imagined intergroup contact and common ingroup identity:an integrative approach

We conducted two studies involving two different age groups (elementary school children and adults) aimed at integrating imagined contact and common ingroup identity models. In the first study, Italian elementary school children were asked to imagine interacting with an unknown immigrant peer as members of a common group. Results revealed that common ingroup imagined contact, relative to a control condition, improved outgroup helping intentions assessed 1 week and 2 weeks after the intervention. In the second study, common ingroup imagined contact led Italian university students to display higher intentions to have contact with immigrants compared to control conditions. In conclusion, results from both studies demonstrate that imagining an intergroup interaction as members of the same group strengthens the effects of imagined contact. These findings point to the importance of combining the common ingroup identity model and the imagined contact theory in order to increase the potentiality of prejudice reduction interventions.