Journal article
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study
BMJ quality & safety, Vol.27(12), pp.954-964
12/2018
DOI: 10.1136/bmjqs-2018-008233
PMID: 30126891
Abstract
BackgroundUnintentional 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.MethodsWe 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.ResultsAcross 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.ConclusionsMentored 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.
Details
- Title: Subtitle
- Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study
- Creators
- Jeffrey L Schnipper - 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, USAAmanda Mixon - Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee, USAJason Stein - Emory University HospitalTosha B Wetterneck - Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USAPeter J Kaboli - Internal Medicine, Iowa City VAMC and University of Iowa, Iowa City, Iowa, USAStephanie Mueller - 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, USAStephanie Labonville - Department of Pharmacy, Brigham and Women’s Hospital, Boston, Massachusetts, USAJacquelyn A Minahan - 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, USAElisabeth Burdick - 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, USAEndel John Orav - Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USAJenna Goldstein - Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania, USANyryan V Nolido - 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, USASunil Kripalani - Department of Medicine and Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee, USA
- Resource Type
- Journal article
- Publication Details
- BMJ quality & safety, Vol.27(12), pp.954-964
- DOI
- 10.1136/bmjqs-2018-008233
- PMID
- 30126891
- ISSN
- 2044-5415
- eISSN
- 2044-5423
- Grant note
- DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality
- Language
- English
- Date published
- 12/2018
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984094506002771
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