TY - JOUR T1 - Is it time for greater patient involvement to enhance transitional medication safety? JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 247 LP - 250 DO - 10.1136/bmjqs-2021-014116 VL - 31 IS - 4 AU - Tamasine C Grimes Y1 - 2022/04/01 UR - http://qualitysafety.bmj.com/content/31/4/247.abstract N2 - In this issue of BMJ Quality & Safety, Schnipper et al report the effects of a refined evidence-based toolkit and mentored implementation of a complex medication reconciliation intervention, ‘MARQUIS2’, at 18 North American hospitals.1 This pragmatic quality improvement study used interrupted time series analysis to quantify the effects of implementation on medication discrepancy rates relative to baseline trends. The MARQUIS2 toolkit was developed by refining the earlier MARQUIS1 toolkit, shown to be associated with a reduction in medication discrepancies but with inconsistent improvement among the five study sites.2 In brief, subsequent changes made to MARQUIS1 included (1) addition of simulated cases as training materials and to assess competency in taking a best possible medication history (BPMH), (2) greater use of pharmacy technicians to take BPMHs, (3) provision of advocacy aids, for example, return-on-investment calculators, to promote resourcing of medication reconciliation, (4) changes to electronic health records’ medication reconciliation functionality and (5) revision of patient/caregiver discharge education materials. The MARQUIS2 toolkit employed both system-level interventions, such as training staff to take a BPMH, and patient-level interventions, such as performing a BPMH. The study reported an increase in the number of system-level interventions adopted per site, an increase in the proportion of patients receiving patient-level interventions over time and a decrease in discrepancies per month over baseline trends. The authors identified that delivery of system-level interventions alone was not associated with decreased discrepancy rates, while receipt of patient-level interventions alone was. The MARQUIS2 study findings therefore provide much-needed insights into the implementation of a medication reconciliation focused intervention across multiple sites. These findings also raise three important questions: are patients currently involved in managing their own medication safety at care transitions, should they be and how or when might this be done?There is evidence that the patient often … ER -