Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study MARQUISReport as inadecuate




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BMC Health Services Research

, 13:230

Quality, performance, safety and outcomes

Abstract

BackgroundUnresolved 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.

MethodsSix 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.

DiscussionAt 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 registrationClinicaltrials.gov identifier NCT01337063

KeywordsMedication reconciliation Hospitalization Quality improvement Care transitions AbbreviationsADEsAdverse drug events

AHRQAgency for healthcare research and quality

AMCAcademic medical center

APNsAdvanced practice nurses

CPOEComputerized physician order entry

FAQFrequently asked questions

HCAHPSHospital consumer assessment of healthcare providers and systems

IRBInstitutional review board

MARQUISMulticenter medication reconciliation quality improvement study

NPs-PAsNurse practitioners-Physician assistants

PIPrimary investigator

QIQuality improvement

SHMSociety of hospital medicine

TJCThe joint commission

VAMCVeterans affairs medical center.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-230 contains supplementary material, which is available to authorized users.

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Author: Amanda H Salanitro - Sunil Kripalani - JoAnne Resnic - Stephanie K Mueller - Tosha B Wetterneck - Katherine Taylor Hayne

Source: https://link.springer.com/







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