Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS)
Patients often have problems after they leave the hospital, in part because errors are made in the medications they are prescribed. The goal of this project is to develop a more accurate and safe medication prescription process when patients enter and leave the hospital and implement this process at six U.S. hospitals. The investigators will measure the success of the project and develop lessons learned so this process can be applied to other hospitals.
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 ] [ Designated as safety issue: Yes ]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 ] [ Designated as safety issue: No ]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 ] [ Designated as safety issue: No ]Emergency Department (ED) or hospital readmission to the same institution within 30 days of discharge, using computerized hospital records of all eligible patients.
|Study Start Date:||March 2011|
|Estimated Study Completion Date:||May 2013|
|Estimated Primary Completion Date:||May 2013 (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
|Contact: Nyryan V Nolido, MAfirstname.lastname@example.org|
|United States, California|
|University of California, San Francisco||Not yet recruiting|
|San Francisco, California, United States, 94143|
|Contact: Andrew Auerbach, MD, MPH 415-502-1412 email@example.com|
|United States, Georgia|
|Emory Johns Creek Hospital||Recruiting|
|Johns Creek, Georgia, United States, 30097|
|Contact: Hasan Shabbir, MD 404-759-7099 firstname.lastname@example.org|
|United States, Illinois|
|University of Chicago Hospitals and Clinics||Not yet recruiting|
|Chicago, Illinois, United States, 60637|
|Contact: Sameer Badlani, MD, MBBS 773-702-5186 email@example.com|
|United States, Massachusetts|
|Baystate Health||Not yet recruiting|
|Springfield, Massachusetts, United States, 01199|
|Contact: Surinder Yadav, MD 413-794-4320 Surinder.Yadav@baystatehealth.org|
|Contact: Randy Pato, MD 413-794-4285 RandolphMD.Peto@baystatehealth.org|
|United States, North Carolina|
|Charlotte, North Carolina, United States, 28204|
|Contact: John Gardella, MD 704-384-9378 firstname.lastname@example.org|
|United States, South Dakota|
|Sioux Falls VA Medical Center||Not yet recruiting|
|Sioux Falls, South Dakota, United States, 57105|
|Contact: Justin Metzger, PharmD 605-336-3230 Justin.Metzger@va.gov|
|Principal Investigator:||Jeffrey L Schnipper, MD, MPH||Brigham and Women's Hospital|