@article{15283,
  author = {Jeffrey L. Schnipper and Harry Reyes Nieva and Meghan Mallouk and Amanda Mixon and Stephanie Rennke and Eugene S. Chu and Stephanie K. Mueller and Gregory (Randy) R Smith Jr and Mark Williams V and Tosha B. Wetterneck and Jason Stein and Anuj Dalal and Stephanie Labonville and Anirudh Sridharan and Deonni P. Stolldorf and E John Orav and Brian Levin and Marcus Gresham and Cathy S. Yoon and Jenna Goldstein and Sara Platt and Christopher Tugbéh Nyenpan and Eric Howell and Sunil Kripalani},
  title = {Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study},
  abstract = {<jats:sec><jats:title>Background</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A 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&lt;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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>A 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.</jats:p></jats:sec>},
  year = {2022},
  journal = {BMJ Qual Saf},
  volume = {31},
  pages = {278-286},
  month = {04/2021},
  publisher = {BMJ},
  issn = {2044-5415},
  doi = {10.1136/bmjqs-2020-012709},
}