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

Jeffrey L Schnipper; Harry Reyes Nieva; Meghan Mallouk; Amanda Mixon; Stephanie Rennke; Eugene Chu; Stephanie Mueller; Gregory (Randy) R Smith Jr; Mark V Williams; Tosha B Wetterneck; Jason Stein; Anuj Dalal; Stephanie Labonville; Anirudh Sridharan; Deonni P Stolldorf; E John Orav; Brian Levin; Marcus Gresham; Cathy Yoon; Jenna Goldstein; Sara Platt; Christopher Tugbéh Nyenpan; Eric Howell; Sunil Kripalani; Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2) Site Leaders

doi:10.1136/bmjqs-2020-012709

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

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

Jeffrey L Schnipper, Harry Reyes Nieva, Meghan Mallouk, Amanda Mixon, Stephanie Rennke, Eugene Chu, Stephanie Mueller, Gregory (Randy) R Smith Jr, Mark V Williams, Tosha B Wetterneck, …

BMJ quality & safety, Vol.31(4), pp.278-286

04/01/2022

DOI: 10.1136/bmjqs-2020-012709

PMCID: PMC10964422

PMID: 33927025

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https://pmc.ncbi.nlm.nih.gov/articles/PMC10964422/pdf/nihms-1972536.pdfView

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Abstract

BackgroundThe 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.MethodsWe 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.ResultsA 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.ConclusionA 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.

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Title: Subtitle: Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study
Creators: Jeffrey L Schnipper - Brigham and Women's Hospital
Harry Reyes Nieva - Brigham and Women's Hospital
Meghan Mallouk - Society of Critical Care Medicine
Amanda Mixon - Vanderbilt University Medical Center
Stephanie Rennke - University of California San Francisco Medical Center
Eugene Chu - Parkland Health & Hospital System
Stephanie Mueller - Brigham and Women's Hospital
Gregory (Randy) R Smith Jr - Northwestern University
Mark V Williams - University of Kentucky
Tosha B Wetterneck - University of Wisconsin–Madison
Jason Stein - Unit, Atlanta, GA, USA
Anuj Dalal - Brigham and Women's Hospital
Stephanie Labonville - Brigham and Women's Hospital
Anirudh Sridharan - Howard County General Hospital
Deonni P Stolldorf - Vanderbilt University
E John Orav - Brigham and Women's Hospital
Brian Levin - Brigham and Women's Hospital
Marcus Gresham - Brigham and Women's Hospital
Cathy Yoon - Brigham and Women's Hospital
Jenna Goldstein - Society of Critical Care Medicine
Sara Platt - Society of Critical Care Medicine
Christopher Tugbéh Nyenpan - Society of Critical Care Medicine
Eric Howell - Johns Hopkins University
Sunil Kripalani - Vanderbilt University Medical Center
Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2) Site Leaders (Institution)
Resource Type: Journal article
Publication Details: BMJ quality & safety, Vol.31(4), pp.278-286
DOI: 10.1136/bmjqs-2020-012709
PMID: 33927025
PMCID: PMC10964422
NLM abbreviation: BMJ Qual Saf
ISSN: 2044-5415
eISSN: 2044-5423
Language: English
Date published: 04/01/2022
Academic Unit: General Internal Medicine; Internal Medicine
Record Identifier: 9984771653502771

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