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

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amanda S. Mixon ◽  
◽  
G. Randy Smith ◽  
Meghan Mallouk ◽  
Harry Reyes Nieva ◽  
...  
Keyword(s):  
Best Practices ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Lessons Learned ◽  
Medication History ◽  
Medication Discrepancies ◽  
Roles And Responsibilities ◽  
Medical Centers ◽  
Phone Calls ◽  
Barriers To Implementation

Abstract Background The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. Methods MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site’s local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. Discussion A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.

scholarly journals A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

2018 ◽  
Vol 25 (11) ◽  
pp. 1488-1500
Author(s):  
Sophie Marien ◽  
Delphine Legrand ◽  
Ravi Ramdoyal ◽  
Jimmy Nsenga ◽  
Gustavo Ospina ◽  
...  
Keyword(s):  
Web Application ◽  
Medication Reconciliation ◽  
Qualitative Data ◽  
Improve Patient Safety ◽  
Three Dimensions ◽  
Medication List ◽  
Medication History ◽  
Medication Discrepancies ◽  
System Usability Scale ◽  
User Centered

Abstract Objective Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the “patient app” and the “MedRec app.” This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app. Methods We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients. Results Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness. Conclusions Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in “real-world” conditions. To achieve adoption and sustained use by patients, the app should meet patients’ needs while also efficiently improving the quality of MedRec.

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

2019 ◽  
Author(s):  
Amanda S Mixon ◽  
Sunil Kripalani ◽  
Jason Stein ◽  
Tosha B Wetterneck ◽  
Peter Kaboli ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Evidence Based ◽  
Health Record ◽  
Medication History ◽  
Pharmacy Staff ◽  
Medication Discrepancies ◽  
Roles And Responsibilities ◽  
Implementation Period ◽  
Treatment Analysis ◽  
And Training

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 distance 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.

scholarly journals An On-Treatment Analysis of the MARQUIS Study: Interventions to Improve Inpatient Medication Reconciliation

2019 ◽  
Vol 14 (10) ◽  
Author(s):  
Amanda S Mixon ◽  
Sunil Kripalani ◽  
Jason Stein ◽  
Tosha B Wetterneck ◽  
Peter Kaboli ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Evidence Based ◽  
Health Record ◽  
Medication History ◽  
Pharmacy Staff ◽  
Medication Discrepancies ◽  
Roles And Responsibilities ◽  
Implementation Period ◽  
Treatment Analysis ◽  
And Training

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.

scholarly journals 2389

2017 ◽  
Vol 1 (S1) ◽  
pp. 38-39
Author(s):  
Molly Wasko ◽  
Elaine Morrato ◽  
Nicholas Kenyon ◽  
Suhrud Rajguru ◽  
Bruce Conway ◽  
...  
Keyword(s):  
Best Practices ◽  
Network Capacity ◽  
Lessons Learned ◽  
Academic Medical Centers ◽  
Conference Calls ◽  
Train The Trainer ◽  
Medical Centers ◽  
Academic Medical ◽  
Teaching Team ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: The goal of this abstract/presentation is to share lessons learned from participation in the NIH SBIR I-Corps Train-The-Trainer Program, discuss our experiences offering programs at our local institutions, and communicate our plans to develop an I-Corps@NCATS program that can be disseminated across the CTSA network. We believe that an I-Corps@NCATS program will enhance the process of scientific translation by taking best practices from NSF I-Corps and adapting the program to meet the needs of biomedical scientists in academic medical centers. By integrating I-Corps@NCATS training, we hypothesize that the clinical and translational investigator base will be better prepared to identify new innovations and to accelerate translation through commercialization. METHODS/STUDY POPULATION: The diverse, interdisciplinary team of investigators involved in this project span 9 CTSA Hubs, including UAB, Rockefeller, UC Denver, HMC-Penn State, UMass, UC Davis, Emory/Georgia Tech, Miami and Michigan. This team was funded by NCATS in 2015–2016 to participate in the CTSA I-Corps Train-The-Trainer Program in conjunction with the NIH-SBIR/STTR I-Corps national program. The goals were to observe the curriculum, interact with and learn from the NSF National Teaching Team and begin implementation of similar programs at our home institutions. Our I-Corps@NCATS team has been holding monthly, and more recently weekly, conference calls to discuss our experiences implementing local programs and to develop a strategy for expanding CTSA offerings that include innovation and entrepreneurship. Our experience revealed several challenges with the existing NSF/NIH I-Corps program offerings: (1) there is no standard curriculum tailored to academic clinical and translational research and biomedical innovations in the life sciences, and (2) the training process to certify instructors in the I-Corps methodology is a much more rigorous and structured process than just observing an I-Corps program (eg, requires mentored training with a national NSF I-Corps trainer). Our team is proposing to address these gaps by taking best practices from NSF I-Corps and adapting the program to create the I-Corps@NCATS Program, tailored to meet the needs of researchers and clinicians in academic medical centers. RESULTS/ANTICIPATED RESULTS: There are 3 primary anticipated results of our project. First, develop a uniform curriculum for the I-Corps@NCATS Program using the National Teaching Team of experts from the NIH’s SBIR I-Corps program. Second, build the I-Corps@NCATS network capacity through a regional Train-The-Trainer Program. Third, develop a set of common metrics to evaluate the effectiveness and impact of the I-Corps@NCATS Program across the community of CTSA Hubs and their respective collaborative networks. DISCUSSION/SIGNIFICANCE OF IMPACT: Over the past 10 years, CTSA Hubs have accelerated science by creating/supporting programs that provide research infrastructure, informatics, pilot funding, education/training, and research navigator services to investigators. These investments help to ensure that we are “doing science right” using the best practices in clinical research. Even so, it is equally important to make investments to ensure that we are “doing the right science.” Are our investigators tackling research problems that our stakeholders, patients, and communities want and need, to make sure that our investments in science have real-world impact? In order to accelerate discoveries toward better health, scientists need to have a better way to understand the needs, wants and desires of the people for whom their research will serve, and how to overcome key obstacles along the path of innovation and commercialization. To fill this gap, we propose that the CTSA Hubs should include in their portfolio of activities a hands-on, lean startup program tailored after the highly successful NSF Innovation Corps (I-Corps) program. We hypothesize that by adapting the NSF I-Corps program to create an I-Corps@NCATS program tailored to medical research, we will better prepare our scientists and engineers to extend their focus beyond the laboratory and broaden the impact of their research. Investigators trained through I-Corps@NCATS are expected to be able to produce more innovative ideas, take a more informed perspective about how to evaluate the clinical and commercial impact of an idea, and quickly prototype and test new solutions in clinical settings.

scholarly journals Identifying Unintentional Medication Discrepancies at Admission among Elderly Inpatients in Vietnam

2021 ◽  
Author(s):  
Phuong Thi Xuan Dong ◽  
Van Thi Thuy Pham ◽  
Linh Thi Nguyen ◽  
Thao Thi Nguyen ◽  
Huong Thi Lien Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admission ◽  
Medication Reconciliation ◽  
Negative Impact ◽  
Medication History ◽  
Medication Discrepancies ◽  
Medication Discrepancy ◽  
Chronic Medication ◽  
Elderly Inpatients

Abstract Background Elderly patients are at high risk of unintentional medication discrepancies during transition care as they are more likely to have multiple comorbidities and chronic diseases that require multiple medications. The main objective of the study was to measure the occurrence and identify risk factors for unintentional medication discrepancies in elderly inpatients during hospital admission.Methods A prospective observational study was conducted from July to December 2018 in a 800-bed geriatric hospital in Hanoi, North Vietnam. Patients over 60 years of age, admitted to one of selected internal medicine wards, taking at least one chronic medication before admission, and staying at least 48 hours were eligible for enrolment. Medication discrepancies of chronic medications before and after admission of each participant were identified by a pharmacist using a step-by-step protocol for the medication reconciliation process. The identified discrepancies were then classified as intentional or unintentional by an assessment group comprised of a pharmacist and a physician. A logistic regression model was used to identify risk factors of medication discrepancies.Results Among 192 enrolled patients, 328 medication discrepancies were identified; of which 87 (26.5%) were unintentional. 32.3% of patients had at least one unintentional medication discrepancy. The most common unintentional medication discrepancy was omission of drugs (75.9% of 87 medication discrepancies). The logistic regression analysis revealed a positive association between the number of discrepancies at admission and the type of treatment wards. Conclusions Medication discrepancies are common at admission among Vietnamese elderly inpatients. This study confirms the importance of obtaining a comprehensive medication history at hospital admission and supports implementing a medication reconciliation program to reduce the negative impact of medication discrepancy, especially for the elderly population.

scholarly journals Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026259 ◽  
Author(s):  
Olivier Giannini ◽  
Nicole Rizza ◽  
Michela Pironi ◽  
Saida Parlato ◽  
Brigitte Waldispühl Suter ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Regression Model ◽  
Poisson Regression ◽  
Medication Reconciliation ◽  
Secondary Outcome ◽  
Poisson Regression Model ◽  
Internal Medicine Ward ◽  
Medication History ◽  
Medication Discrepancies ◽  
Standard Medication

ObjectiveMedication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including abest possible medication history(BPMH) compared with a standard medication history in patients admitted to an internal medicine ward.DesignProspective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model.SettingInternal medicine ward in a secondary care hospital in Southern Switzerland.ParticipantsThe first 100 consecutive patients admitted in an internal medicine ward.Primary and secondary outcome measuresMedication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified.ResultsThe median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model.ConclusionEven in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.

scholarly journals Electronic tools to support medication reconciliation: a systematic review

2016 ◽  
Vol 24 (1) ◽  
pp. 227-240 ◽  
Author(s):  
Sophie Marien ◽  
Bruno Krug ◽  
Anne Spinewine
Keyword(s):  
User Satisfaction ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Cochrane Library ◽  
Future Research ◽  
Successful Implementation ◽  
Multiple Sources ◽  
Medication History ◽  
Quality Of Reporting ◽  
Medication Discrepancies

Objectives: Medication reconciliation (MedRec) is essential for reducing patient harm caused by medication discrepancies across care transitions. Electronic support has been described as a promising approach to moving MedRec forward. We systematically reviewed the evidence about electronic tools that support MedRec, by (a) identifying tools; (b) summarizing their characteristics with regard to context, tool, implementation, and evaluation; and (c) summarizing key messages for successful development and implementation. Materials and Methods: We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and the Cochrane Library, and identified additional reports from reference lists, reviews, and patent databases. Reports were included if the electronic tool supported medication history taking and the identification and resolution of medication discrepancies. Two researchers independently selected studies, evaluated the quality of reporting, and extracted data. Results: Eighteen reports relative to 11 tools were included. There were eight quality improvement projects, five observational effectiveness studies, three randomized controlled trials (RCTs) or RCT protocols (ie, descriptions of RCTs in progress), and two patents. All tools were developed in academic environments in North America. Most used electronic data from multiple sources and partially implemented functionalities considered to be important. Relevant information on functionalities and implementation features was frequently missing. Evaluations mainly focused on usability, adherence, and user satisfaction. One RCT evaluated the effect on potential adverse drug events. Conclusion: Successful implementation of electronic tools to support MedRec requires favorable context, properly designed tools, and attention to implementation features. Future research is needed to evaluate the effect of these tools on the quality and safety of healthcare.

Whole-of-Government Crisis Management: From Research to Practice

2021 ◽  
Author(s):  
Kathryn H. Floyd
Keyword(s):  
Best Practices ◽  
Crisis Management ◽  
Terrorist Attack ◽  
Lessons Learned ◽  
Surge Capacity ◽  
Roles And Responsibilities ◽  
Pivotal Moments ◽  
National Power ◽  
Government Crisis Management ◽  
Mix And Match

When a crisis manifests, the problem or situation is often at a terrible point where sage and timely decisions are of critical importance. Ideally, the particular emergency has been known previously and various challenges, roadblocks, and solutions workshopped in a tabletop or other exercise. Whether in advance or at a sudden precipice, a whole-of-government approach can navigate, mitigate, and alleviate the disaster in a holistic and comprehensive manner that is tailored to the task at hand. Whole-of-government crisis management—at the local, state, national, or international level—involves several elements. First, those in command need to know the myriad of players who may have roles and responsibilities to play at pivotal moments. Every organization will not be required in every crisis, and a strategic mix and match is often valuable. Second, each agency needs to understand how it fits into the larger puzzle and adjust their internal culture accordingly to support interagency operations, regardless of who is providing a lead function and who is supporting. Then, the agencies must have the staff available to fulfill their tasks and surge capacity, making provisions for alternative personnel or a “backbench” to execute everyday operations while the frontlines are busy. Elements of whole-of-government approaches appear throughout all aspects of crisis management. A relatively recent term, whole of government is an expansive framework for coordinating interagency responses that is often invoked in policy documents, as well as examined in academic studies. As it is adopted by various administrations and organizations during times of calm and emergency, the whole-of-government approach has aspects that are enduring, countervailing, and aspirational. The instruments of national power—diplomatic, information, military, and economic (DIME)—provide one lens through which to examine whole-of-government crisis management. Past interagency responses demonstrate best practices and difficult lessons learned for future whole-of-government operations. A broad analysis of whole-of-government crisis management enables government leaders, practitioners, scholars, researchers, and others to create comprehensive and flexible strategies with delineated roles for dedicated interagency partners in advance of the next hurricane or terrorist attack.

scholarly journals Roles for Pharmacy Technicians in Medication Reconciliation During Transitions of Care

2016 ◽  
Vol 33 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Nicole A. Fabiilli ◽  
Mary F. Powers
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Medication Reconciliation ◽  
Improve Patient Safety ◽  
Transitions Of Care ◽  
Care Providers ◽  
Medication Discrepancies ◽  
Pharmacy Technician ◽  
Pharmacy Technicians

Objective: To provide an overview of medication reconciliation and to identify opportunities for pharmacy technicians to help improve patient safety and quality of care. Data Sources: Articles were identified through searches conducted in May 2016 by means of MEDLINE/PubMed (2000-2016) using search terms designed to identify English-language articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Additionally, resources on medication reconciliation were used from The Joint Commission, the Institute for Healthcare Improvement, American Pharmacists Association, American Society of Health-System Pharmacists, and Agency for Healthcare Research and Quality. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list. Pharmacy technicians can help resolve discrepancies in medication lists, therefore improving patient care, the ability of pharmacists to communicate with physicians, and thus to clinically intervene in patient care. Furthermore, with proper training, pharmacy technicians may take on expanded roles designed to aid pharmacists with advanced patient care services to eliminate medication discrepancies and improve transition of care. Conclusions: Pharmacy technicians can play a vital role in helping pharmacists to obtain accurate patient medication histories in order to decrease medication discrepancies at transitions of care.

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