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BMC Health Serv Res. 2019 Sep 11;19(1):659. doi: 10.1186/s12913-019-4491-5.

Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation.

Author information

1
GRECC, VA Tennessee Valley Healthcare System and Section of Hospital Medicine, Vanderbilt University Medical Center, Suite 450, 2525 West End Avenue, Nashville, TN, 37203, USA. Amanda.S.Mixon@vumc.org.
2
Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
3
Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, PA, USA.
4
Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
5
Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
6
Division of Hospital Medicine, University of California San Francisco Medical Center, San Francisco, CA, USA.
7
Division of Hospital Medicine, Parkland Health and Hospital System and Department of Internal Medicine, University of Texas Southwestern School of Medicine, Dallas, TX, USA.
8
Howard County General Hospital, Columbia, MD, USA.
9
Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
10
Division of General Internal Medicine, University of Wisconsin, Madison, WI, USA.
11
1Unit, Atlanta, GA, USA.
12
School of Nursing, Vanderbilt University, Nashville, TN, USA.
13
Division of Collaborative Inpatient Medicine Service, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
14
Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, PA, USA.

Abstract

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.

KEYWORDS:

Hospital medicine; Medication errors; Medication reconciliation; Patient safety; Quality improvement; Transitions in care

PMID:
31511070
PMCID:
PMC6737715
DOI:
10.1186/s12913-019-4491-5
[Indexed for MEDLINE]
Free PMC Article

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