Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety

实施药物协调工具包以提高患者安全

• 批准号: 9353749
• 负责人: Jeffrey Lawrence Schnipper
• 金额: $ 48.71万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2019-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9353749
• 关键词: Implementation; Medication; Reconciliation; Toolkit; Improve

 DESCRIPTION (provided by applicant): Medication discrepancies, i.e., unexplained differences in medication regimens across different sites of care, are very common and represent a major threat to patient safety. One solution is medication reconciliation. The AHRQ-funded Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) conducted at five US hospitals consolidated best practices and rigorously evaluated them in a real-world setting. Results showed significant reductions in potentially harmful medication discrepancies. The MARQUIS toolkit, now refined based on lessons learned from the prior study, provides a scalable and testable approach to markedly improve medication safety at numerous institutions. The long-term objective of this research is to widely disseminate, implement, and evaluate sustainable medication reconciliation interventions that improve patient safety during care transitions. We aim to implement the refined MARQUIS toolkit at 18 diverse hospitals using a mentored implementation model, to rigorously evaluate the effects on unintentional medication discrepancies, and to evaluate the success of implementation using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to inform future dissemination. Prospective sites will be selected based on their interest and on their readiness to participate (e.g., demonstration of institutional support and data collection resources). Mentors will conduct one site visit and monthly phone calls to assist local site leaders with implementation. The MARQUIS toolkit will include a core "medication reconciliation bundle"; the use of more intensive interventions in high-risk patients; provider training and the use of dedicated personnel for certain tasks (e.g., discharge medication counseling); improving access to pre-admission medication sources (e.g., by empowering patients to maintain their own medication lists); improving implementation of information technology; and social marketing techniques aimed at both patients and providers. The primary outcome will be the number of unintentional medication discrepancies in admission and discharge orders using methods refined over several studies and analyzed using segmented regression methods to measure improvement over baseline temporal trends. Program evaluation using RE-AIM will provide lessons to inform the spread of future medication reconciliation interventions. A Patient-Family Advisory Council will ensure that patients assume a vital role in the research effort. Dissemination plans will be developed with input from a multi-stakeholder team. This project will provide valuable information regarding the most effective ways to support safe medication use and improve health care delivery during care transitions.

 描述（由申请人提供）：用药差异，即，在不同的护理地点，药物治疗方案的无法解释的差异是非常常见的，并且对患者的安全构成了重大威胁。一个解决方案是药物和解。AHRQ资助的多中心药物协调质量改进研究（MARQUIS）在五家美国医院进行，巩固了最佳实践，并在现实世界中对其进行了严格评估。结果显示，潜在有害的药物差异显着减少。MARQUIS工具包现在根据先前研究的经验教训进行了改进，提供了一种可扩展和可测试的方法，可显着提高许多机构的药物安全性。 这项研究的长期目标是广泛传播，实施和评估可持续的药物协调干预措施，以提高患者在护理过渡期间的安全性。我们的目标是在18家不同的医院使用指导实施模型实施改进的MARQUIS工具包，严格评估对无意用药差异的影响，并使用RE-AIM框架（范围，有效性，采用，实施和维护）评估实施的成功，以告知未来的传播。 将根据研究中心的兴趣和参与意愿（例如，机构支持和数据收集资源的示范）。指导人员将进行一次现场访问，并每月打电话，以协助当地现场负责人实施。MARQUIS工具包将包括一个核心的“药物协调包”;在高风险患者中使用更密集的干预措施;提供者培训和使用专门人员执行某些任务（例如，出院药物咨询）;改善对入院前药物来源的访问（例如，使病人能够保持自己的药物清单）;改进信息技术的实施;以及针对病人和提供者的社会营销技术。主要结局将是入院和出院顺序中意外用药差异的数量，使用经过几项研究改进的方法，并使用分段回归方法进行分析，以测量基线时间趋势的改善。使用RE-AIM的项目评估将为未来药物协调干预的传播提供经验教训。一个患者家庭咨询理事会将确保患者在研究工作中发挥重要作用。将在多方利益攸关方小组的投入下制定传播计划。 该项目将提供有关最有效的方法，以支持安全用药和改善医疗服务的护理过渡期间提供有价值的信息。

项目成果

Implementation and sustainability of a medication reconciliation toolkit: A mixed methods evaluation.

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
• 发表时间: 2020
• 期刊: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
• 作者: Stolldorf,DeonniP;Mixon,AmandaS;Auerbach,AndrewD;Aylor,AmyR;Shabbir,Hasan;Schnipper,Jeff;Kripalani,Sunil
• 通讯作者: Kripalani,Sunil

What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study.

药物协调的有效方法：MARQUIS2 研究的治疗中和现场分析。

• DOI: 10.1136/bmjqs-2022-014806
• 发表时间: 2023
• 期刊: BMJ quality & safety
• 影响因子: 5.4
• 作者: Schnipper,JeffreyL;ReyesNieva,Harry;Yoon,Catherine;Mallouk,Meghan;Mixon,AmandaS;Rennke,Stephanie;Chu,EugeneS;Mueller,StephanieK;SmithJr,GRandy;Williams,MarkV;Wetterneck,ToshaB;Stein,Jason;Dalal,AnujK;Labonville,Stephan
• 通讯作者: Labonville,Stephan

Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility.

通过退伍军人事务部熟练护理机构的综合评估改善药物协调。

• DOI: 10.1016/j.jcjq.2021.06.001
• 发表时间: 2021
• 期刊: Joint Commission journal on quality and patient safety
• 影响因子: 2.3
• 作者: Baughman,AmyW;Triantafylidis,LauraK;O'Neil,Nicole;Norstrom,Jeni;Okpara,Kelechi;Ruopp,MarcusD;Linsky,Amy;Schnipper,Jeffrey;Mixon,AmandaS;Simon,StevenR
• 通讯作者: Simon,StevenR