Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation
-
Published:2019-09-11
Issue:1
Volume:19
Page:
-
ISSN:1472-6963
-
Container-title:BMC Health Services Research
-
language:en
-
Short-container-title:BMC Health Serv Res
Author:
Mixon Amanda S.ORCID, , Smith G. Randy, Mallouk Meghan, Nieva Harry Reyes, Kripalani Sunil, Rennke Stephanie, Chu Eugene, Sridharan Anirudh, Dalal Anuj, Mueller Stephanie, Williams Mark, Wetterneck Tosha, Stein Jason M., Stolldorf Deonni, Howell Eric, Orav John, Labonville Stephanie, Levin Brian, Yoon Catherine, Gresham Marcus, Goldstein Jenna, Platt Sara, Nyenpan Christopher, Schnipper Jeffrey L.,
Abstract
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.
Funder
Agency for Healthcare Research and Quality National Center for Research Resources National Center for Advancing Translational Sciences U.S. Department of Veterans Affairs
Publisher
Springer Science and Business Media LLC
Reference34 articles.
1. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7. 2. Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414–22. 3. Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, Shintani A, Sponsler KC, Harris LJ, Theobald C, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1–10. 4. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565–71. 5. Institute for Healthcare Improvement: Medication reconciliation review. Available at
http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/BMHMemphisMedicationReconciliationForm.htm
. Accessed 11 Dec 2007.
Cited by
18 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|