Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
BMC Health Serv Res. 2013 Jun 25;13:230. doi: 10.1186/1472-6963-13-230.
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.
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.
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.
Clinicaltrials.gov identifier NCT01337063.
住院期间未解决的药物差异可能导致药物不良事件，从而对患者造成伤害。通过执行药物重整可以减少差异；然而，事实证明，有效的药物重整实施具有挑战性。多中心药物重整质量改进研究（MARQUIS）的目标是实施住院患者药物重整的最佳实践，测试其对潜在有害的非故意药物差异的影响，并了解成功实施的障碍和促进因素。
六家美国医院参与了这项质量改进指导实施研究。每家医院都收集了主要结果的基线数据：每位患者潜在有害的非故意药物差异数量，由经过培训的现场药剂师通过“黄金标准”药物史确定。在导师的指导下，每个地点还开始实施一项或多项改善药物重整的 11 项最佳实践。为了了解实施干预措施对医院员工和文化的影响，我们正在进行混合方法计划评估，包括对一线员工和医院领导进行调查、访谈和焦点小组。
在基线时，每位患者入院和出院医嘱中的非故意药物差异数量因地点而异，从 2.35 到 4.67（平均值为 3.35）。大多数差异是由于病史错误（每位患者平均 2.12 个）而不是重整错误（每位患者平均 1.23 个）。潜在有害的药物差异平均每位患者为 0.45 个，因地点而异，从每位患者 0.13 到 0.82 个不等。我们讨论了迄今为止遇到的一些实施障碍。最终，我们预计 MARQUIS 工具和经验教训有可能减少药物差异并改善患者结果。
Clinicaltrials.gov 标识符 NCT01337063。
