Disseminating Best Practices in Inpatient Medication Reconciliation

Grace C. Huang, MD

The MARQUIS initiative provides a toolkit for hospitals to institute medication reconciliation initiatives.

The Society of Hospital Medicine and the Agency for Healthcare Research and Quality collaborated to launch an initiative to address medication reconciliation on a national level. Investigators in the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) aimed to develop and assess a toolkit of best practices and a mentored quality-improvement (QI) strategy for implementing medication reconciliation programs. Materials were determined by expert consensus, a recent systematic review, and the success of past national mentored QI projects.

In addition to providing guidelines, onsite preparation, and assessment, the intervention components detail the following process for applying best practices in medication reconciliation:

• Assign roles and responsibilities.
• Improve access to preadmission medication sources.
• Use medication list templates for patients.
• Obtain the best possible medication history.
• Provide discharge counseling.
• Identify patients at excess risk for medication discrepancies.
• Use medication reconciliation bundles for high-risk patients.
• Use information technology to facilitate access to data and comparison of medication lists.
• Phase in implementation.
• Seek community engagement.

The authors describe two case studies and lessons learned from implementation, including necessary engagement of frontline providers, nursing leadership support, and the value of site visits. Feedback from institutions showed high satisfaction with instructional video materials and mentors, but also noted challenges in devoting resources to implementation. To date, outcomes are self-reported only, but chart audits by pharmacists are planned.

Citation(s):

Mueller SK et al. A toolkit to disseminate best practices in inpatient medication reconciliation: Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). Jt Comm J Qual Patient Saf 2013 Aug; 39:371.