An On‐Treatment Analysis of the MARQUIS Study: Interventions to Improve Inpatient Medication Reconciliation

Abstract

It is unclear which medication reconciliation interventions are most effective at reducing inpatient medication discrepancies. Five United States hospitals’ interdisciplinary quality improvement (QI) teams were virtually mentored by QI-trained physicians. Sites implemented one to seven evidence-based interventions in 791 patients during the 25-month implementation period. Three interventions were associated with significant decreases in potentially harmful discrepancy rates: (1) defining clinical roles and responsibilities, (2) training, and (3) hiring staff to perform discharge medication reconciliation. Two interventions were associated with significant increases in potentially harmful discrepancy rates: training staff to take medication histories and implementing a new electronic health record (EHR). Hospitals should focus first on hiring and training pharmacy staff to assist with medication reconciliation at discharge and delineating roles and responsibilities of clinical staff. We caution hospitals implementing a large vendor EHR, as medication discrepancies may increase. Finally, the effect of medication history training on discrepancies needs further study.

Evaluation of an educational strategy to improve medication reconciliation in ambulatory care

“…A hospital-based educational program found an increase in knowledge and self-e cacy for proper medication reconciliation from pre-and post-surveys (16). Improving knowledge is important and may improve the quality of medication lists gathered through medication reconciliation, but the effect on outcomes is less clear (17)(18)(19). Similar to our ndings, others have found that providing education alone is not enough to guarantee consistently accurate medication reconciliation (17)(18)(19).…”

“…Improving knowledge is important and may improve the quality of medication lists gathered through medication reconciliation, but the effect on outcomes is less clear (17)(18)(19). Similar to our ndings, others have found that providing education alone is not enough to guarantee consistently accurate medication reconciliation (17)(18)(19). Additionally, a previous study conducted by our group identi ed numerous barriers to medication reconciliation including lack of time, lack of patient knowledge, and lack of a standardized work ow (4).…”

The Rural VA Multi-Center Medication Reconciliation Quality Improvement Study (R-VA-MARQUIS)

“…26 Prior studies have shown that pharmacy-driven medication reconciliation processes and patient counseling at discharge can reduce unintentional medication discrepancies and preventable ADEs. [27][28][29] Site 3's reduction in unintentional medication discrepancies after hiring an inpatient clinical pharmacist and implementing a pharmacy-driven discharge-medication reconciliation and counseling process reinforces the importance of this type of intervention. Site 2's results differed from those in a prior study in which unintentional medication discrepancies were reduced after implementing pharmacy technicians to obtain admission medication histories.…”

Interprofessional survey on medication reconciliation activities in the US Department of Veterans’ Affairs: development and validation of an Implementation Readiness Questionnaire

“…For example, compared with nurses and pharmacists, physicians tend to prioritise other tasks in a resource-constrained setting 26. Therefore, it is crucial for organisational leaders to identify local champions, sponsor human factors evaluations and identify dedicated personnel (eg, pharmacy technicians) based on clinic resources and characteristics 8 19 49…”