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01.12.2019 | Study protocol | Ausgabe 1/2019 Open Access

BMC Health Services Research 1/2019

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

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2019
Autoren:
Amanda S. Mixon, G. Randy Smith Jr, Meghan Mallouk, Harry Reyes Nieva, Sunil Kripalani, Stephanie Rennke, Eugene Chu, Anirudh Sridharan, Anuj Dalal, Stephanie Mueller, Mark Williams, Tosha Wetterneck, Jason M. Stein, Deonni Stolldorf, Eric Howell, John Orav, Stephanie Labonville, Brian Levin, Catherine Yoon, Marcus Gresham, Jenna Goldstein, Sara Platt, Christopher Nyenpan, Jeffrey L. Schnipper, the MARQUIS2 Site Leaders, the MARQUIS2 Study Group
Wichtige Hinweise
Portions of this information were previously presented at the Annual Meeting of the Society of Hospital Medicine on April 9, 2018 and Annual Meeting of the Society of General Internal Medicine on April 12, 2018.

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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.
Literatur
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