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Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study
  1. Jeffrey L Schnipper1,
  2. Amanda Mixon2,3,
  3. Jason Stein4,
  4. Tosha B Wetterneck5,
  5. Peter J Kaboli6,
  6. Stephanie Mueller1,
  7. Stephanie Labonville7,
  8. Jacquelyn A Minahan1,
  9. Elisabeth Burdick1,
  10. Endel John Orav8,
  11. Jenna Goldstein9,
  12. Nyryan V Nolido1,
  13. Sunil Kripalani10
  1. 1 Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3 Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
  4. 4 Internal Medicine, Emory University Hospital, Atlanta, Georgia, USA
  5. 5 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  6. 6 Internal Medicine, Iowa City VAMC and University of Iowa, Iowa City, Iowa, USA
  7. 7 Department of Pharmacy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  8. 8 Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
  9. 9 Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
  10. 10 Department of Medicine and Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Jeffrey L Schnipper, Division of General Medicine, Brigham and Women’s Hospital Department of Medicine, Boston, MA 02115-6110, USA; jschnipper{at}partners.org

Abstract

Background Unintentional discrepancies across care settings are a common form of medication error and can contribute to patient harm. Medication reconciliation can reduce discrepancies; however, effective implementation in real-world settings is challenging.

Methods We conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The intervention consisted of local implementation of medication reconciliation best practices, utilising an evidence-based toolkit with 11 intervention components. Trained QI mentors conducted monthly site phone calls and two site visits during the intervention, which lasted from December 2011 through June 2014. The primary outcome was number of potentially harmful unintentional medication discrepancies per patient; secondary outcome was total discrepancies regardless of potential for harm. Time series analysis used multivariable Poisson regression.

Results Across five sites, 1648 patients were sampled: 613 during baseline and 1035 during the implementation period. Overall, potentially harmful discrepancies did not decrease over time beyond baseline temporal trends, adjusted incidence rate ratio (IRR) 0.97 per month (95% CI 0.86 to 1.08), p=0.53. The intervention was associated with a reduction in total medication discrepancies, IRR 0.92 per month (95% CI 0.87 to 0.97), p=0.002. Of the four sites that implemented interventions, three had reductions in potentially harmful discrepancies. The fourth site, which implemented interventions and installed a new electronic health record (EHR), saw an increase in discrepancies, as did the fifth site, which did not implement any interventions but also installed a new EHR.

Conclusions Mentored implementation of a multifaceted medication reconciliation QI initiative was associated with a reduction in total, but not potentially harmful, medication discrepancies. The effect of EHR implementation on medication discrepancies warrants further study.

Trial registration number NCT01337063.

  • medication reconciliation
  • medication safety
  • pharmacists
  • quality improvement

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Footnotes

  • Contributors JLS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: JLS, JS, TBW, PJK, SL, SK. Acquisition, analysis or interpretation of data: JLS, AM, JS, TBW, PJK, SM, JAM, EB, EJO, JG, NVN, SK. Drafting of the manuscript: JLS, SK. Critical revision of the manuscript for important intellectual content: JLS, AM, JS, TBW, PJK, SM, JAM, EB, EJO, JG, NVN, SK. Statistical analysis: EJO, EB. Administrative, technical or material support: JAM, JG, NVN. Study supervision: JLS.

  • Funding This study was supported by the Agency for Healthcare Research and Quality (grant number: R18 HS019598).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The funding agency was not involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.

  • Competing interests JLS has received funding from Mallinckrodt Pharmaceuticals for an investigator-initiated study of opioid-related adverse drug events in postsurgical patients. AM was funded by a VA HSR&D Career Development Award (12-168). SK has served as a consultant to Verustat.

  • Patient consent Not required.

  • Ethics approval Partners Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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