Abstract
Background: Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Methods. Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a "gold standard" medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. Discussion. At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Trial registration. Clinicaltrials.gov identifier NCT01337063.
| Original language | English |
|---|---|
| Article number | 230 |
| Journal | BMC Health Services Research |
| Volume | 13 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2013 |
Bibliographical note
Funding Information:Though medication reconciliation practices are required at care transitions throughout hospitalization, implementation has been challenging for many hospitals because it often involves a dramatic change in work processes and additional tasks for busy clinicians. Furthermore, the implementation of medication reconciliation interventions varies widely across hospitals, and hospitals need clearer guidance on which interventions are more likely to be successful in their local environment [15]. Moreover, it has been relatively easy for hospitals to document compliance with medication reconciliation processes to meet national and international standards without demonstrating that medication safety has actually improved. To identify and address the barriers to implementing medication reconciliation, an Agency for Healthcare Research and Quality (AHRQ)-funded conference organized by the Society of Hospital Medicine (SHM) in 2009 brought together 36 key stakeholders from 20 organizations representing healthcare policy, patient safety, regulatory, technology, and consumer and medical professional groups. The conference yielded a White Paper with recommendations, including a call for further research [16]. To address the latter, SHM subsequently received funding from AHRQ to conduct the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS; clinicaltrials.gov identifier NCT01337063). The specific aims of MARQUIS are to:
Funding
Though medication reconciliation practices are required at care transitions throughout hospitalization, implementation has been challenging for many hospitals because it often involves a dramatic change in work processes and additional tasks for busy clinicians. Furthermore, the implementation of medication reconciliation interventions varies widely across hospitals, and hospitals need clearer guidance on which interventions are more likely to be successful in their local environment [15]. Moreover, it has been relatively easy for hospitals to document compliance with medication reconciliation processes to meet national and international standards without demonstrating that medication safety has actually improved. To identify and address the barriers to implementing medication reconciliation, an Agency for Healthcare Research and Quality (AHRQ)-funded conference organized by the Society of Hospital Medicine (SHM) in 2009 brought together 36 key stakeholders from 20 organizations representing healthcare policy, patient safety, regulatory, technology, and consumer and medical professional groups. The conference yielded a White Paper with recommendations, including a call for further research [16]. To address the latter, SHM subsequently received funding from AHRQ to conduct the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS; clinicaltrials.gov identifier NCT01337063). The specific aims of MARQUIS are to:
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | R18HS019598 |
| Agency for Healthcare Research and Quality | NCT01337063 |
Keywords
- Care transitions
- Hospitalization
- Medication reconciliation
- Quality improvement
ASJC Scopus subject areas
- Health Policy
