Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS)
|Adverse Drug Events Medication Administered in Error||Other: Mentored medication reconciliation quality improvement|
|Study Design:||Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Health Services Research
|Official Title:||Multi-Center Medication Reconciliation Quality Improvement Study|
- The primary outcome will be unintentional medication discrepancies in admission orders and discharge orders with potential for patient harm [ Time Frame: 6 months prior to implementation of intervention to 21 months during intervention ]The primary outcome will be determined by a study pharmacist who will take a "gold standard" medication history on 5 patients per week, then compare that history to the medical team's medication history, to admission orders, and to discharge orders. Any unintentional medication discrepancies in orders will be recorded. A physician adjudicator will then make a final determination regarding whether an error occurred, the type of error, the potential for patient harm, and the potential severity.
- Patient satisfaction [ Time Frame: 6 months prior to implementation of intervention to 21 months during intervention ]Patient Satisfaction will be assessed using data from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This survey is already administered to a sample of patients from all hospitals; we will measure both global satisfaction and questions related to medications (e.g., "before giving you any new medications, how often did hospital staff tell you what the medicine was for," and "before giving you any new medications, how often did hospital staff describe possible site effects in a way you could understand.")
- Administrative outcomes [ Time Frame: 6 months prior to implementation of intervention to 21 months during intervention ]Emergency Department (ED) or hospital readmission to the same institution within 30 days of discharge, using computerized hospital records of all eligible patients.
- Total medication discrepancies [ Time Frame: 6 months prior to implementation of intervention to 21 months during intervention ]As with Outcome 1, but without adjudication for potential for harm
|Study Start Date:||March 2011|
|Study Completion Date:||September 2014|
|Primary Completion Date:||September 2014 (Final data collection date for primary outcome measure)|
No Intervention: Pre-intervention
Usual care regarding medication reconciliation as currently practiced at each participating site.
Improved medication reconciliation process using continuous quality improvement methods, mentored implementation, and an implementation guide.
Other: Mentored medication reconciliation quality improvement
Based on expert recommendations from a recent conference on medication reconciliation sponsored by the Society of Hospital Medicine and funded by AHRQ, investigators will engage a steering committee and conduct a second conference to operationalize these recommendations into a set of "best practice" guidelines, standards, and tools to be adapted by each of 6 participating sites. After training mentors and developing data collection tools, a mentored quality improvement project will be conducted for 21 months, in which each site works to improve medication reconciliation using the toolkit and with mentorship in the form of two site visits and monthly phone calls.
Unintentional medication discrepancies during transitions in care (such as hospitalization and subsequent discharge) are very common and represent a major threat to patient safety. One solution to this problem is medication reconciliation. In response to Joint Commission requirements, most hospitals have developed medication reconciliation processes, but some have been more successful than others, and there are reports of pro-forma compliance without substantial improvements in patient safety. There is now collective experience about effective approaches to medication reconciliation, but these have yet to be consolidated, evaluated rigorously, and disseminated effectively.
This project's findings should provide valuable lessons to all hospitals regarding the best ways to design and implement medication reconciliation interventions to improve medication safety during transitions in care.
Aim 1: Develop a toolkit consolidating the best practice recommendations for medication reconciliation
Aim 2: Conduct a multi-center mentored quality improvement project in which each site adapts the tools for its own environment and implements them
Aim 3: Assess the effects of a mentored medication reconciliation quality improvement intervention on unintentional medication discrepancies with potential for patient harm
Aim 4: Conduct rigorous program evaluation to determine the most important components of a medication reconciliation program and how best to implement it
Please refer to this study by its ClinicalTrials.gov identifier: NCT01337063
|United States, California|
|University of California, San Francisco|
|San Francisco, California, United States, 94143|
|United States, Georgia|
|Emory Johns Creek Hospital|
|Johns Creek, Georgia, United States, 30097|
|United States, Illinois|
|University of Chicago Hospitals and Clinics|
|Chicago, Illinois, United States, 60637|
|United States, Massachusetts|
|Springfield, Massachusetts, United States, 01199|
|United States, North Carolina|
|Charlotte, North Carolina, United States, 28204|
|United States, South Dakota|
|Sioux Falls VA Medical Center|
|Sioux Falls, South Dakota, United States, 57105|
|Principal Investigator:||Jeffrey L Schnipper, MD, MPH||Brigham and Women's Hospital|