Medications at Transitions and Clincal Handoffs (MATCH)

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DESCRIPTION (provided by the applicant): It has been estimated that medication errors cause at least 7,000 deaths per year primarily among hospitalized patients and that 40 percent occur during the prescribing phase. Safe medication use relies on an accurate, complete and current medication history for every patient admitted to an acute care hospital. The Medications at Transitions and Clinical Handoffs (MATCH) project will implement a practical, effective and replicable strategy to reduce medication errors and associated harm among hospitalized patients through effective medication reconciliation. The goal of MATCH is to measurably decrease the number of discrepant medication orders by training nursing and medical staff in medication history interviewing skills while implementing a single medication history list within our medical record, utilized by all clinicians. The proposed project, focused on the medicine service at an urban, academic medical center will: (1) analyze implementation of an integrated, multidisciplinary process to improve inpatient medication reconciliation at admission, transfer and discharge; (2) assess the acceptability of and compliance with new medication reconciliation procedures by hospital staff; (3) based on a random sample of 2000 patient interviews, measure whether the proportion of patients who experience medication reconciliation failures declines following implementation and the reasons for such failures; (4) identify patient risk factors frequently responsible for inaccurate medication reconciliation, including Limited English Proficiency and Low Health Literacy, complex medication histories, lack of social support, or impaired cognitive status; and (5) develop a toolkit that can be widely disseminated to other acute care hospitals including strategies for patient involvement, staff education, workflow redesign, and feedback to healthcare workers. The toolkit will include resources for measurement of error and associated potential or actual harm (outcome); safe process design principles, evaluation tools and education and training tools. Additionally, as relatively little information is available on identifying patient risk factors, our evaluation will identify targets for more intensive efforts to reduce medication errors in the most cost-effective manner.