Implementation and sustainability of a medication reconciliation toolkit: A mixed methods evaluation

Area of Science:

• Healthcare Quality Improvement
• Medication Safety
• Implementation Science

Background:

• Medication reconciliation is crucial for patient safety.
• The MARQUIS (Multi-Center Medication Reconciliation Quality Improvement Study) toolkit aimed to enhance medication reconciliation programs.
• Understanding implementation factors is key for successful healthcare interventions.

Purpose of the Study:

• To describe the implementation of the MARQUIS toolkit in hospitals.
• To identify barriers and facilitators to toolkit adoption and sustainability.
• To explore factors enhancing the spread of medication reconciliation best practices.

Main Methods:

• A mixed-methods study design combining quantitative surveys and qualitative phone interviews.
• Involved site leaders from five participating hospitals in the MARQUIS study.
• Utilized the Consolidated Framework for Implementation Research to guide data collection and analysis.

Main Results:

• MARQUIS toolkit implementation enhanced existing medication reconciliation practices.
• Executive leadership support was present, but institutional support for staffing and budget was limited.
• Hospitals shifted staff responsibilities, designated champions, and used various strategies like EHR templates and counseling.

Conclusions:

• Hospitals can successfully implement, spread, and sustain the MARQUIS toolkit despite resource limitations.
• Shifting staff responsibilities and adding pharmacy staff are key strategies.
• Leadership support and resources facilitate implementation, while staff buy-in and competing priorities can be barriers.