Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.

Hospitals Humans Medication Reconciliation Mentors Patient Discharge Quality Improvement

healthcare quality improvement medication reconciliation patient safety pharmacists transitions in care

Journal

BMJ quality & safety

ISSN: 2044-5423

Titre abrégé: BMJ Qual Saf

Pays: England

ID NLM: 101546984

Informations de publication

Date de publication:
04 2022

Historique:

received: 11 11 2020

revised: 26 03 2021

accepted: 10 04 2021

pubmed: 1 5 2021

medline: 3 5 2022

entrez: 30 4 2021

Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND

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.

Identifiants

DOI: 10.1136/bmjqs-2020-012709 PMID: 33927025

pubmed: 33927025

pii: bmjqs-2020-012709

doi: 10.1136/bmjqs-2020-012709

doi:

Types de publication

Journal Article Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S.

Langues

eng

Pagination

278-286

Investigateurs

Sanchita Sen (S)

Samer Badr (S)

Michelle Murphy (M)

Corrie Vasilopoulos (C)

Tara Vlasimsky (T)

Christine Roussel (C)

Olugbenga Arole (O)

Loredana Diana Berescu (LD)

Arif Arifuddowla (A)

Hattie Main (H)

Susan Pickle (S)

Cristy Singleton (C)

Brenda Asplund (B)

Andrea Delrue (A)

Andrea Forgione (A)

Colleen Shipman (C)

Luigi Brunetti (L)

Hina Ahmed (H)

Adrian Gonzales (A)

Mithu Molla (M)

Sarah Bajorek (S)

Andrea Nguyen (A)

Robert El-Kareh (R)

Kyle Koenig (K)

Loutfi Succari (L)

Scott Kincaid (S)

Pamela Proctor (P)

Robert Pendleton (R)

Amy Baughman (A)

Kimberly Boothe (K)

Katarzyna Szablowski (K)

Olukemi Akande (O)

Eric Tichy (E)

Chi Zheng (C)

Ryan Centafont (R)

Regina Jahrstorfer (R)

Lisa Jaser (L)

Isha John (I)

Margaret Curtin (M)

Jenna Swindler (J)

Joe Marcus (J)

Robert Osten (R)

Tian Yaw (T)

Zainulabdeen Al-Jammali (Z)

Nancy Doherty (N)

Brandi Hamilton (B)

Magdee Hugais (M)

Samson Lee (S)

Paul Sabatini (P)

Eddie Eabisa (E)

Jennifer Mello (J)

Julianna Burton (J)

Edward Fink (E)

Anthony Biondo (A)

Trina Huynh (T)

Ken Kormorny (K)

Adonice Khoury (A)

Kathryn Ruf (K)

Dwayne Pierce (D)

Chadrick Lowther (C)

Karli Edholm (K)

Shantel Mullin (S)

Nicole Murphy (N)

Jeni Norstrom (J)

Laura Driscoll (L)

Maribeth Cabie (M)

Andrew Cadorette (A)

Sara John (S)

Amy D'Silva (A)

Lionel Picot-Vierra (L)

Informations de copyright

Déclaration de conflit d'intérêts

Competing interests: JLS has received funding from Mallinckrodt Pharmaceuticals for an investigated-initiated study of opioid-related adverse drug events. JLS and AM received remuneration from American Society of Health-System Pharmacists (ASHP) to develop their best possible medication history training curriculum.