Abstract
BackgroundThe 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.MethodsMARQUIS2 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.DiscussionA 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.
Highlights
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
At the time of MARQUIS2 most sites already had established vendor electronic health record (EHR), so we focused on relatively simple changes they could make to their existing systems, including standardized note templates for medication history-takers and giving proper permissions to personnel to make medication history changes in the EHR
Evaluation of implementation One of the specific aims of MARQUIS2 was the evaluation of the program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework [18]
Summary
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. Problem description Medication errors are a major patient safety concern during transitions in care and occur across all healthcare settings. When discrepancies are unintentional and unresolved, they can cause harmful adverse drug events (ADEs) and substantially increase health care costs [3, 4]. Using this list to provide correct medications for patients anywhere within the health care system,” is required at all care transitions to reduce actual and potential harm caused by medication discrepancies [5]. The quality of medication reconciliation remains poor, and evidence-based practice is lacking [8]
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