Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study. Issue 4 (29th April 2021)

• Record Type: Journal Article
• Authors: Schnipper, Jeffrey L; Reyes Nieva, Harry; Mallouk, Meghan; Mixon, Amanda; Rennke, Stephanie; Chu, Eugene; Mueller, Stephanie; Smith Jr, Gregory (Randy) R; Williams, Mark V; Wetterneck, Tosha B; Stein, Jason; Dalal, Anuj; Labonville, Stephanie; Sridharan, Anirudh; Stolldorf, Deonni P; Orav, E John; Levin, Brian; Gresham, Marcus; Yoon, Cathy; Goldstein, Jenna; Platt, Sara; Nyenpan, Christopher Tugbéh; Howell, Eric; Kripalani, Sunil
• Other Names: author non-byline.; Sen Sanchita author non-byline.; Badr Samer author non-byline.; Murphy Michelle author non-byline.; Vasilopoulos Corrie author non-byline.; Vlasimsky Tara author non-byline.; Roussel Christine author non-byline.; Arole Olugbenga author non-byline.; Berescu Loredana Diana author non-byline.; Arifuddowla Arif author non-byline.; Main Hattie author non-byline.; Pickle Susan author non-byline.; Singleton Cristy author non-byline.; Asplund Brenda author non-byline.; Delrue Andrea author non-byline.; Forgione Andrea author non-byline.; Shipman Colleen author non-byline.; Brunetti Luigi author non-byline.; Ahmed Hina author non-byline.; Gonzales Adrian author non-byline.; Molla Mithu author non-byline.; Bajorek Sarah author non-byline.; Nguyen Andrea author non-byline.; El-Kareh Robert author non-byline.; Koenig Kyle author non-byline.; Succari Loutfi author non-byline.; Kincaid Scott author non-byline.; Proctor Pamela author non-byline.; Pendleton Robert author non-byline.; Baughman Amy author non-byline.; Boothe Kimberly author non-byline.; Szablowski Katarzyna author non-byline.; Akande Olukemi author non-byline.; Tichy Eric author non-byline.; author non-byline.; Zheng Chi author non-byline.; Centafont Ryan author non-byline.; Jahrstorfer Regina author non-byline.; Jaser Lisa author non-byline.; John Isha author non-byline.; Curtin Margaret author non-byline.; Swindler Jenna author non-byline.; Marcus Joe author non-byline.; Osten Robert author non-byline.; Yaw Tian author non-byline.; Al-Jammali Zainulabdeen author non-byline.; Doherty Nancy author non-byline.; Hamilton Brandi author non-byline.; Hugais Magdee author non-byline.; Lee Samson author non-byline.; Sabatini Paul author non-byline.; Eabisa Eddie author non-byline.; Mello Jennifer author non-byline.; Burton Julianna author non-byline.; Fink Edward author non-byline.; Biondo Anthony author non-byline.; Huynh Trina author non-byline.; Kormorny Ken author non-byline.; Khoury Adonice author non-byline.; Ruf Kathryn author non-byline.; Pierce Dwayne author non-byline.; Lowther Chadrick author non-byline.; Edholm Karli author non-byline.; Mullin Shantel author non-byline.; Murphy Nicole author non-byline.; Norstrom Jeni author non-byline.; Driscoll Laura author non-byline.; Cabie Maribeth author non-byline.; Cadorette Andrew author non-byline.; John Sara author non-byline.; D'Silva Amy author non-byline.; Picot-Vierra Lionel author non-byline.;
• Is Part Of: BMJ quality & safety. Volume 31:Issue 4(2022)
• Page Start: 278
• Page End: 286
• Publication Date: 2021-04-29
• Subjects: medication reconciliation -- patient safety -- healthcare quality improvement -- transitions in care -- pharmacists; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2020-012709
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: The first Multicenter Medication Reconciliation Quality Improvement (QI) Study (MARQUIS1) demonstrated that mentored implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The objective of this study was to determine the effects of a refined toolkit on a larger group of hospitals. Methods: We conducted a pragmatic quality improvement study (MARQUIS2) at 18 North American hospitals or hospital systems from 2016 to 2018. Incorporating lessons learnt from MARQUIS1, we implemented a refined toolkit, offering 17 system-level and 6 patient-level interventions. One of eight physician mentors coached each site via monthly calls and performed one to two site visits. The primary outcome was number of unintentional medication discrepancies in admission or discharge orders per patient. Time series analysis used multivariable Poisson regression. Results: A total of 4947 patients were sampled, including 1229 patients preimplementation and 3718 patients postimplementation. Both the number of system-level interventions adopted per site and the proportion of patients receiving patient-level interventions increased over time. During the intervention, patients experienced a steady decline in their medication discrepancy rate from 2.85 discrepancies per patient to 0.98 discrepancies per patient. An interrupted time series analysis of the 17 sites with sufficient data for analysis showed the intervention was associated with a 5% relative decrease in discrepancies per month over baseline temporal trends (adjusted incidence rate ratio: 0.95, 95% CI 0.93 to 0.97, p<0.001). Receipt of patient-level interventions was associated with decreased discrepancy rates, and these associations increased over time as sites adopted more system-level interventions. Conclusion: A multicentre medication reconciliation QI initiative using mentored implementation of a refined best practices toolkit, including patient-level and system-level interventions, was associated with a substantial decrease in unintentional medication discrepancies over time. Future efforts should focus on sustainability and spread.