Implementation and sustainability of a medication reconciliation toolkit: A mixed methods evaluation.
Implementation and sustainability of a medication reconciliation toolkit: A mixed methods evaluation.
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药物协调工具包的实施和可持续性：混合方法评估。
DOI：
10.1093/ajhp/zxaa136
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Kripalani,Sunil
中科院分区：
文献类型：
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作者：
Stolldorf,DeonniP;Mixon,AmandaS;Auerbach,AndrewD;Aylor,AmyR;Shabbir,Hasan;Schnipper,Jeff;Kripalani,Sunil
目的：emarquis（多中心药物和解质量改进研究）为参与研究的医院提供了一个工具包，以协助制定健全的药物和解计划。在这里，我们描述了医院对MARQUIS工具包的实施，障碍和促进因素，以及可能增强工具包传播和可持续性的重要因素。方法采用定量-定性混合研究设计。我们邀请参与MARQUIS的5家医院的现场领导完成了网络调查和电话访谈。《实施研究综合框架》指导问题的发展。我们使用描述性统计（调查回复）和专题内容分析（访谈结果）来分析收集到的数据。结果各侯爵医院现场领导参与。他们报告说，MARQUIS工具包的实施增强了他们医院现有但有限的药物和解实践。调查结果表明，行政领导支持工具包的实施，但对招聘员工（20%的受访者报告）和/或实施预算支持（60%的受访者报告）的机构支持有限。大多数参与医院（80%）将员工职责转移到支持药物和解。访谈结果显示，内部环境（如组织环境）和过程因素（如冠军的指定）对实施既有抑制作用，也有促进作用。医院采用了各种工具包干预措施（例如，出院药物咨询），采用了一系列实施战略，包括为工作人员开发教育工具和提示单以及电子健康记录模板。结论尽管机构支持有限，但医院可以通过转移工作人员职责、增加药学人员以及采用多种策略促进实施，成功实施、推广和维持MARQUIS工具包。虽然领导层的支持和数据收集和传播的资源促进了执行，但有限的工作人员参与和相互竞争的优先事项可能阻碍执行。
PurposeMARQUIS (Multi-Center Medication Reconciliation Quality Improvement Study) provided participating hospitals with a toolkit to assist in developing robust medication reconciliation programs. Here we describe hospitals’ implementation of the MARQUIS toolkit, barriers and facilitators, and important factors that may enhance the spread and sustainability of the toolkit.MethodsWe used a mixed methods, quantitative-qualitative study design. We invited site leaders of the 5 hospitals that participated in MARQUIS to complete a Web-based survey and phone interview. The Consolidated Framework for Implementation Research guided question development. We analyzed the collected data using descriptive statistics (for survey responses) and thematic content analysis (for interview results).ResultsSite leaders from each MARQUIS hospital participated. They reported that MARQUIS toolkit implementation augmented their hospitals’ existing but limited medication reconciliation practices. Survey results indicated executive leadership support for toolkit implementation but limited institutional support for hiring staff (reported by 20% of respondents) and/or budgetary support for implementation (reported by 60% of respondents). Most participating hospitals (80%) shifted staff responsibilities to support medication reconciliation. Interview findings showed that inner setting (ie, organizational setting) and process factors (eg, designation of champions) both inhibited and facilitated implementation. Hospitals adopted a variety of toolkit interventions (eg, discharge medication counseling) using a range of implementation strategies, including development of educational tools and tip sheets for staff members and electronic health record templates.ConclusionDespite limited institutional support, hospitals can successfully implement, spread, and sustain the MARQUIS toolkit by shifting staff responsibilities, adding pharmacy staff, and using a variety of strategies to facilitate implementation. Although leadership support and resources for data collection and dissemination facilitated implementation, limited staff buy-in and competing priorities may hinder implementation.