Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS)

• Type of Material: Article
• Authors: Amanda H. Salanitro, Vanderbilt University; Sunil Kripalani, Vanderbilt University; JoAnne Resnic, Society of Hospital Medicine; Stephanie K. Mueller, Harvard University; Tosha B. Wetterneck, University of Wisconsin; Katherine Taylor Haynes, Vanderbilt University; Jason M Stein, Emory University; Peter J. Kaboli, University of Iowa; Stephanie Labonville, Brigham and Women's Hospital; Edward Etchells, University of Toronto; Daniel J. Cobaugh, American Society of Health-System Pharmacists Research and Education Foundation; David Hanson, American Association of Critical Care Nurses; Jeffrey L. Greenwald, Harvard University; Mark V. Williams, Northwestern University; Jeffrey L. Schnipper, Harvard University
• Language: English
• Date: 2013-06-25
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Salanitro et al.; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.biomedcentral.com/1472-6963/13/230
• Title of Journal or Parent Work: BMC Health Services Research
• ISSN: 1472-6963
• Volume: 13
• Issue: 230
• Start Page: 1
• End Page: 12
• Grant/Funding Information: Agency for Healthcare Research and Quality (AHRQ) R18HS019598-01 to the Society of Hospital Medicine (SHM) with Dr. Schnipper as principle investigator.
• Keywords: Hospitalization; Care transitions; Medication reconciliation; Quality improvement
• Research Categories: Health Sciences, Health Care Management

Abstract

Background Unresolved 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. Methods Six 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. Discussion At 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 registration Clinicaltrials.gov identifier NCT01337063