Open Access Highly Accessed Study protocol

Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS)

Amanda H Salanitro12*, Sunil Kripalani2, JoAnne Resnic3, Stephanie K Mueller4, Tosha B Wetterneck5, Katherine Taylor Haynes6, Jason Stein7, Peter J Kaboli8, Stephanie Labonville9, Edward Etchells10, Daniel J Cobaugh11, David Hanson12, Jeffrey L Greenwald13, Mark V Williams14 and Jeffrey L Schnipper15

Author Affiliations

1 Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA

2 Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN, USA

3 Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, PA, USA

4 Division of General Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

5 Center for Quality and Productivity Improvement, UW Madison; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

6 Peabody College, Vanderbilt University, Nashville, TN, USA

7 Department of Medicine Quality Program, Emory University, Atlanta, GA, USA

8 The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, University of Iowa Carver College of Medicine, Iowa City, IA, USA

9 Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA, USA

10 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

11 American Society of Health-System Pharmacists Research and Education Foundation, Bethesda, MD, USA

12 American Association of Critical Care Nurses, Aliso Viejo, CA, USA

13 Inpatient Clinician Educator Service, Massachusetts General Hospital; Harvard Medical School, Boston, MA, USA

14 Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

15 BWH Hospitalist Service, Division of General Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, MA, USA

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BMC Health Services Research 2013, 13:230  doi:10.1186/1472-6963-13-230

Published: 25 June 2013

Abstract

Background

Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation.

Methods

Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a “gold standard” medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders.

Discussion

At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes.

Trial registration

Clinicaltrials.gov identifier NCT01337063

Keywords:
Medication reconciliation; Hospitalization; Quality improvement; Care transitions