Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation

Mixon, Amanda S.; Smith, G. Randy; Mallouk, Meghan; Nieva, Harry Reyes; Kripalani, Sunil; Rennke, Stephanie; Chu, Eugene S.; Sridharan, Anirudh; Dalal, Anuj K.; Mueller, Stephanie; Williams, Mark; Wetterneck, Tosha B.; Stein, Jason; Stolldorf, Deonni P.; Howell, Eric; Orav, John; Labonville, Stephanie; Levin, Brian; Yoon, Catherine; Gresham, Marcus; Goldstein, Jenna; Platt, Sara; Nyenpan, Christopher; Schnipper, Jeffrey L.; Sen, Sanchita; Badr, Samer; Murphy, Michelle M.; Vasilopoulos, Corrie; Vlasimsky, Tara; Roussel, Christine; Arole, Olugbenga; Berescu, Loredana Diana; Arifuddowla, Arif; Main, Hattie; Pickle, Susan; Singleton, Cristy; Asplund, B; Delrue, Andrea; Forgione, Andrea; Shipman, Colleen; Brunetti, Luigi; Ahmed, Hina; Gonzales, Adrian J.; Molla, Mithu; Bojerek, Sarah; Nguyen, Andrea; El‐Kareh, Robert; Koenig, Kyle; Succari, Loutfi; Kincaid, Scott; Proctor, Pamela; Pendleton, Robert C.; Baughman, Amy W.; Boothe, Kimberly; Szablowski, Katarzyna; Akande, Olukemi; Tichy, Eric M.; Zheng, Chi; Centafont, Ryan A.; Jahrstorfer, Regina; Jaser, Lisa; John, I; Curtin, Margaret; Swindler, Jenna; Marcus, Joe; Osten, Robert; Yaw, Tian; Al-Jammali, Zainulabdeen; Doherty, Nancy; Hamilton, Brandi; Hugais, Magdee; Lee, Samson; Sabatini, Paul V.; Eabisa, Eddie; Mello, Jennifer; Burton, Julianna; Fink, Edward L.; Biondo, Anthony; Huynh, Trina; Kormorny, Ken; Khoury, Adonice; Ruf, Kathryn M.; Pierce, Dwayne; Lowther, Chadrick; Edholm, Karli; Mullin, Shantel; Murphy, Nicole; Norstrom, Jeni; Driscoll, Laura; Cabie, Maribeth; Cadorette, Andrew; John, Sara; D'Silva, Amy; Picot-Vierra, Lionel

doi:10.1186/s12913-019-4491-5

Cited by 19 publications

(17 citation statements)

References 27 publications

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“…However, the study showed that effectiveness varied across sites. Incorporating lessons learnt from that study using implementation science methods, we refined the toolkit and our approach to implementation and conducted MARQUIS2 at 18 diverse hospitals in North America 17–19. Over the 18-month study, medication discrepancies decreased from 2.85 to 0.98 per patient, equating to a 5% adjusted relative decrease in discrepancies per month over baseline temporal trends 20…”

Section: Introductionmentioning

confidence: 99%

What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study

et al. 2023

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BackgroundThe second Multicenter Medication Reconciliation Quality Improvement Study demonstrated a marked reduction in medication discrepancies per patient. The aim of the current analysis was to determine the association of patient exposure to each system-level intervention and receipt of each patient-level intervention on these results.MethodsThis study was conducted at 17 North American Hospitals, the study period was 18 months per site, and sites typically adopted interventions after 2–5 months of preintervention data collection. We conducted an on-treatment analysis (ie, an evaluation of outcomes based on patient exposure) of system-level interventions, both at the category level and at the individual component level, based on monthly surveys of implementation site leads at each site (response rate 65%). We then conducted a similar analysis of patient-level interventions, as determined by study pharmacist review of documented activities in the medical record. We analysed the association of each intervention on the adjusted number of medication discrepancies per patient in admission and discharge orders, based on a random sample of up to 22 patients per month per site, using mixed-effects Poisson regression with hospital site as a random effect. We then used a generalised linear mixed-effects model (GLMM) decision tree to determine which patient-level interventions explained the most variance in discrepancy rates.ResultsAmong 4947 patients, patient exposure to seven of the eight system-level component categories was associated with modest but significant reductions in discrepancy rates (adjusted rate ratios (ARR) 0.75–0.97), as were 15 of the 17 individual system-level intervention components, including hiring, reallocating and training personnel to take a best possible medication history (BPMH) and training personnel to perform discharge medication reconciliation and patient counselling. Receipt of five of seven patient-level interventions was independently associated with large reductions in discrepancy rates, including receipt of a BPMH in the emergency department (ED) by a trained clinician (ARR 0.40, 95% CI 0.37 to 0.43), admission medication reconciliation by a trained clinician (ARR 0.57, 95% CI 0.50 to 0.64) and discharge medication reconciliation by a trained clinician (ARR 0.64, 95% CI 0.57 to 0.73). In GLMM decision tree analyses, patients who received both a BPMH in the ED and discharge medication reconciliation by a trained clinician experienced the lowest discrepancy rates (0.08 per medication per patient).Conclusion and relevancePatient-level interventions most associated with reductions in discrepancies were receipt of a BPMH of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were associated with modest reduction in discrepancies for the average patient but are likely important to support patient-level interventions and may reach more patients. These findings can be used to help hospitals and health systems prioritise interventions to improve medication safety during care transitions.

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Section: Introductionmentioning

confidence: 99%

What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study

et al. 2023

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“…It requires extensive use of resources [ 8 , 16 ], wide-scale organizational change [ 17 – 19 ], interprofessional collaboration [ 20 ], and workflow redesign [ 8 , 16 , 19 , 21 , 22 ]. Reports demonstrate these complexities create multiple barriers to successful MedRec implementation including a lack of role clarity, insufficient interprofessional collaboration, and limited organizational capacity including personnel resources and time commitments [ 10 , 19 , 22 – 25 ]. Despite identified MedRec implementation challenges [ 19 , 20 ], and growing recognition that implementation strategies are key to successfully adopting and implementing healthcare interventions, existing MedRec studies focus predominantly on clinical outcomes of MedRec [ 26 – 29 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Multicenter Medication Reconciliation Quality Improvement Study (i.e., MARQUIS) [ 1 , 33 ] and the Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety study (i.e., MARQUIS2) [ 25 , 33 ], developed an evidence-based MedRec Toolkit (i.e., MARQUIS Toolkit) and evaluated the effect of the toolkit on medication discrepancies in 5 hospitals and 18 hospitals, respectively. Seventeen system-level interventions representing 8 domains comprise the latest version of the MARQUIS Toolkit [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation strategies in the context of medication reconciliation: a qualitative study

Stolldorf

Ridner

Vogus

et al. 2021

Implement Sci Commun

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Background Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. How to best implement MedRec interventions remains unclear. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, we report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit). Methods A qualitative study was conducted with implementation teams and executive leaders of hospitals participating in the federally funded “Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety” (known as MARQUIS2) research study. Data consisted of transcripts from web-based focus groups and individual interviews, as well as meeting minutes. Interview data were transcribed and analyzed using content analysis and the constant comparison technique. Results Data were collected from 16 hospitals using 2 focus groups, 3 group interviews, and 11 individual interviews, 10 sites’ meeting minutes, and an email interview of an executive. Major categories of implementation strategies predominantly mirrored the ERIC strategies of “Plan,” “Educate,” “Restructure,” and “Quality Management.” Participants rarely used the ERIC strategies of finance and attending to policy context. Two new non-ERIC categories of strategies emerged—“Integration” and “Professional roles and responsibilities.” Of the 73 specific strategies in the ERIC taxonomy, 32 were used to implement the MARQUIS Toolkit and 11 new, and non-ERIC strategies were identified (e.g., aligning with existing initiatives and professional roles and responsibilities). Conclusions Complex interventions like the MARQUIS MedRec Toolkit can benefit from the ERIC taxonomy, but adaptations and new strategies (and even categories) are necessary to fully capture the range of approaches to implementation.

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Section: Introductionmentioning

confidence: 99%

“…[8] Inappropriate dose prescribing also includes medication dose modifications done by the hospital medicine team, often Internal Medicine residency trainees and graduates, on patient discharge and before patients being seen by their PCPs. [9] There does not appear to be any research about whether IMHS possess the necessary awareness and knowledge to prescribe the correct doses of antidiabetic medications in patients with CKD. This study reports percentages for incorrect level of awareness for antidiabetic medication dose adjustment in patients with CKD (ILA) and also incorrect level of knowledge of ILK-GFR for Glipizide, Pioglitazone, and Sitagliptin in patients with impaired renal function.…”

Section: Introductionmentioning

confidence: 99%

Dose adjustment of antidiabetic medications in chronic kidney disease

et al. 2021

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Purpose : The purpose of this study is to identify whether Internal Medicine house-staff (IMHS) have awareness and knowledge about the correct dosage of antidiabetic medications for patients with chronic kidney disease (CKD), as dosing errors result in adverse patient outcomes for those with diabetes mellitus (DM) and CKD. Methods : There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone, and Sitagliptin. Results : Lack of awareness and knowledge was high, with the highest for Pioglitazone at 72.8%. For ILA, the percentages were: Pioglitazone: 72.8%, Glipizide: 43.9%, and Sitagliptin: 42.8%. For ILK-GFR, the percentages were: Pioglitazone: 72.8%, Glipizide: 68.3%, and Sitagliptin: 65.4%. Conclusions : IMHS have poor awareness and knowledge for antidiabetic medication dose adjustment in patients with DM and CKD. Both Electronic Medical Rerecord best practice advisory and physician–pharmacist collaborative drug therapy management can enhance safe drug prescribing in patients with CKD. In addition, IMHS’s practice for antidiabetic medication dose adjustment was better with Nephrology exposure. A formal didactic educational training during medical school and residency for antidiabetic medication dose adjustment in patients with DM and CKD is highly encouraged to prevent medication dosing errors and to more effectively and safely allow IMHS to manage complex treatment regimens.

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Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation

Cited by 19 publications

References 27 publications

What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study

What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study

Implementation strategies in the context of medication reconciliation: a qualitative study

Dose adjustment of antidiabetic medications in chronic kidney disease

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