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

Amanda S. Mixon, G. Randy Smith, 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 GreshamJenna Goldstein, Sara Platt, Christopher Nyenpan, Jeffrey L. Schnipper, Sanchita Sen, Samer Badr, Michelle Murphy, Corrie Vasilopoulos, Tara Vlasimsky, Christine Roussel, Olugbenga Arole, Loredana Diana Berescu, Arif Arifuddowla, Hattie Main, Susan Pickle, Cristy Singleton, Brenda Asplund, Andrea Delrue, Andrea Forgione, Colleen Shipman, Luigi Brunetti, Hina Ahmed, Adrian Gonzales, Mithu Molla, Sarah Bojerek, Andrea Nguyen, Robert El-Kareh, Kyle Koenig, Loutfi Succari, Scott Kincaid, Pamela Proctor, Robert Pendleton, Amy Baughman, Kimberly Boothe, Katarzyna Szablowski, Olukemi Akande, Eric Tichy, Chi Zheng, Ryan Centafont, Regina Jahrstorfer, Lisa Jaser, Isha John, Margaret Curtin, Jenna Swindler, Joe Marcus, Robert Osten, Tian Yaw, Zainulabdeen Al-Jammali, Nancy Doherty, Brandi Hamilton, Magdee Hugais, Samson Lee, Paul Sabatini, Eddie Eabisa, Jennifer Mello, Julianna Burton, Edward Fink, Anthony Biondo, Trina Huynh, Ken Kormorny, Adonice Khoury, Kathryn Ruf, Dwayne Pierce, Chadrick Lowther, Karli Edholm, Shantel Mullin, Nicole Murphy, Jeni Norstrom, Laura Driscoll, Maribeth Cabie, Andrew Cadorette, Sara John, Amy D'Silva, Lionel Picot-Vierra

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number659
JournalBMC health services research
Volume19
Issue number1
DOIs
StatePublished - Sep 11 2019

Keywords

  • Hospital medicine
  • Medication errors
  • Medication reconciliation
  • Patient safety
  • Quality improvement
  • Transitions in care

ASJC Scopus subject areas

  • Health Policy

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    Mixon, A. S., Smith, G. R., Mallouk, M., Nieva, H. R., Kripalani, S., Rennke, S., Chu, E., Sridharan, A., Dalal, A., Mueller, S., Williams, M., Wetterneck, T., Stein, J. M., Stolldorf, D., Howell, E., Orav, J., Labonville, S., Levin, B., Yoon, C., ... Picot-Vierra, L. (2019). Design of MARQUIS2: Study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation. BMC health services research, 19(1), [659]. https://doi.org/10.1186/s12913-019-4491-5