The MARQUIS Initiative Offers Tools and Resources to Improve Medication Reconciliation Practices

Medication reconciliation at the time of admission as well as at patient discharge can prevent significant harm from adverse drug events (ADEs), yet about two thirds of front-line providers have never learned to take a Best Possible Medical History (BPMH); a similar number feel they lack time for gold-standard medication reconciliation with high-risk patients. Jeffrey Schnipper, MD, MPH, and several colleagues spoke to these issues and shared case studies from ongoing work with the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) at the Society for Hospital Medicine’s 2013 annual conference, held May 17-19 at the National Harbor’s Gaylord Nelson Convention Center in Ft. Washington, MD.

MARQUIS is a multi-center medication reconciliation quality improvement (QI) initiative with aims that include sharing a toolkit of best practices for obtaining a BPMH, implementing a multi-site mentored QI model, assessing the effects of interventions on unintentional medication discrepancies, and conducting program evaluation (including surveys, focus groups, interviews, and site visits) to identify important components of effective medication reconciliation, and how to effect change where needed.

Physician adjudicators assist in determining the primary outcome, the number of potentially harmful unintentional medication discrepancies per patient. Six sites are currently enrolled: three academic medical centers, two community hospitals, and one VA hospital. The sites vary in size, academic affiliation, and health IT use. For 977 patients studied at baseline across all sites, of a mean 3.77 medication discrepancies per patient, 0.46 were judged to be potentially harmful. Data collection is ongoing.

Two participating case study hospitals were presented by Jason Stein, MD, of Emory University. The first, Presbyterian Hospital, had a number of pre-existing success factors; determining existing strengths is an important aspect of the MARQUIS project, so intervention can be targeted where it is most needed. This facility was already utilizing a Medication Reconciliation Assistants (MRA) program, using specially trained pharmacy technicians to obtain a gold-standard BPMH as patients are admitted. The BPMH includes extensive verification from secondary sources such as pharmacies, primary physicians, and family members. Additionally, about 10% of patients deemed most at-risk received intensive post-discharge medication review and counseling. Barriers, which seem nearly uniform across facilities, included the need for delineation of role competency (who does what and when?), initial and ongoing competency training, and availability of competent personnel to complete BPMH’s and post-discharge education in a timely fashion. Currently, the facility is seeing approximately a 33% reduction in medication discrepancies.

The second hospital case study, Emory Johns Creek, also had several pre-existing strengths. These included strong QI team leadership and an engaged, broad-reaching team. Successes of this facility’s initiative have included training front-line providers in BPMH and best-practice discharge counseling, the creation of a new hospital medication reconciliation policy which sets out clear expectations of roles and deadlines, and improving EMR functionality for discharge medication lists. The team has successfully built a business case to pay for a new MRA program, demonstrating ROI based on reduced costs associated with ADEs and readmissions.

Click here for further information and a downloadable toolkit.