Background: The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. Methods: MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. Discussion: A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.
|Journal||BMC Health Services Research|
|State||Published - Sep 11 2019|
Bibliographical noteFunding Information:
Dr. Schnipper has received funding from Mallinckrodt Pharmaceuticals for an investigated-initiated study of opioid-related adverse drug events and from Portola Pharmaceuticals for an investigator-initiated study of inpatients who decline subcutaneous venous thromboembolism prophylaxis. No other authors have conflicts of interest or financial disclosures.
This study was supported by a grant from the Agency for Healthcare Research and Quality, R18 HS023757 (Dr. Schnipper) and in part by grant UL1 RR024975–01 from the National Center for Research Resources and grant 2 UL1 TR000445–06 from the National Center for Advancing Translational Sciences. Dr. Mixon was funded by a VA HSR&D Career Development Award (12–168). Dr. Stolldorf was funded by grant K01HS025486 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily
© 2019 The Author(s).
- Hospital medicine
- Medication errors
- Medication reconciliation
- Patient safety
- Quality improvement
- Transitions in care
ASJC Scopus subject areas
- Health Policy