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Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve
Amanda S Mixon1, G Randy Smith2, Meghan Mallouk3
1GRECC, VA Tennessee Valley Healthcare System and Section of Hospital Medicine, Vanderbilt University Medical Center, Suite 450, 2525 West End Avenue, Nashville, TN, 37203, USA. Amanda.S.Mixon@vumc.org.
Background:
The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.
Methods:
MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.
Discussion:
A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.
Insights
The MARQUIS2 study successfully implemented a medication reconciliation toolkit across 18 diverse hospitals, reducing medication errors. Lessons learned emphasize trained staff and patient involvement for improved medication safety.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Medication Management
Background:
- The initial MARQUIS1 study showed a medication reconciliation toolkit reduced discrepancies in five hospitals.
- MARQUIS2 aimed to implement this toolkit in more varied hospital settings, using MARQUIS1's lessons.
Purpose of the Study:
- To implement and assess a mentored, multi-center quality improvement (QI) initiative for medication reconciliation.
- To adapt and apply lessons learned from the previous MARQUIS1 study in diverse healthcare environments.
Main Methods:
- A pragmatic, mentored QI study involving 18 medical centers over 18 months.
- Implementation of a revised toolkit focusing on best possible medication history, discharge reconciliation, clinician roles, risk stratification, health IT, medication access, discrepancy correction, and stakeholder engagement.
- Mentorship provided through site visits and monthly calls, with local QI teams adapting toolkit components.
Main Results:
- Successful implementation of the mentored QI initiative across 18 diverse medical centers.
- The study involved sites varying in size, teaching status, location, and electronic health record (EHR) platforms.
- Identified key barriers and lessons learned for effective implementation.
Conclusions:
- A mentored, multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented.
- Key lessons include the importance of dedicated, trained personnel for medication history, simplified EHR solutions, clear role definitions, and patient/family input.
- The study highlights the adaptability of the MARQUIS toolkit across different hospital types.
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