Multi-Center Medication Reconciliation Quality Improvement Study
- Conditions
- Medication Administered in ErrorAdverse Drug Events
- Interventions
- Other: Mentored medication reconciliation quality improvement
- Registration Number
- NCT01337063
- Lead Sponsor
- Brigham and Women's Hospital
- Brief Summary
Patients often have problems after they leave the hospital, in part because errors are made in the medications they are prescribed. The goal of this project is to develop a more accurate and safe medication prescription process when patients enter and leave the hospital and implement this process at six U.S. hospitals. The investigators will measure the success of the project and develop lessons learned so this process can be applied to other hospitals.
- Detailed Description
Unintentional medication discrepancies during transitions in care (such as hospitalization and subsequent discharge) are very common and represent a major threat to patient safety. One solution to this problem is medication reconciliation. In response to Joint Commission requirements, most hospitals have developed medication reconciliation processes, but some have been more successful than others, and there are reports of pro-forma compliance without substantial improvements in patient safety. There is now collective experience about effective approaches to medication reconciliation, but these have yet to be consolidated, evaluated rigorously, and disseminated effectively.
This project's findings should provide valuable lessons to all hospitals regarding the best ways to design and implement medication reconciliation interventions to improve medication safety during transitions in care.
SPECIFIC AIMS:
Aim 1: Develop a toolkit consolidating the best practice recommendations for medication reconciliation
Aim 2: Conduct a multi-center mentored quality improvement project in which each site adapts the tools for its own environment and implements them
Aim 3: Assess the effects of a mentored medication reconciliation quality improvement intervention on unintentional medication discrepancies with potential for patient harm
Aim 4: Conduct rigorous program evaluation to determine the most important components of a medication reconciliation program and how best to implement it
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1836
- Age 18 and over
- Admitted to inpatient medical or surgical services
- Vulnerable populations (pregnant women, prisoners, institutionalized individuals)
- Under 18 years
Hospital staff subjects:
- Personnel directly involved in the medication reconciliation process, which depending on the site might include residents, physician assistants, inpatient attending physicians, nurses, pharmacists, and pharmacy technicians.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Intervention Mentored medication reconciliation quality improvement Improved medication reconciliation process using continuous quality improvement methods, mentored implementation, and an implementation guide.
- Primary Outcome Measures
Name Time Method The primary outcome will be unintentional medication discrepancies in admission orders and discharge orders with potential for patient harm 6 months prior to implementation of intervention to 21 months during intervention The primary outcome will be determined by a study pharmacist who will take a "gold standard" medication history on 5 patients per week, then compare that history to the medical team's medication history, to admission orders, and to discharge orders. Any unintentional medication discrepancies in orders will be recorded. A physician adjudicator will then make a final determination regarding whether an error occurred, the type of error, the potential for patient harm, and the potential severity.
- Secondary Outcome Measures
Name Time Method Patient satisfaction 6 months prior to implementation of intervention to 21 months during intervention Patient Satisfaction will be assessed using data from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This survey is already administered to a sample of patients from all hospitals; we will measure both global satisfaction and questions related to medications (e.g., "before giving you any new medications, how often did hospital staff tell you what the medicine was for," and "before giving you any new medications, how often did hospital staff describe possible site effects in a way you could understand.")
Total medication discrepancies 6 months prior to implementation of intervention to 21 months during intervention As with Outcome 1, but without adjudication for potential for harm
Administrative outcomes 6 months prior to implementation of intervention to 21 months during intervention Emergency Department (ED) or hospital readmission to the same institution within 30 days of discharge, using computerized hospital records of all eligible patients.
Trial Locations
- Locations (6)
Presbyterian Hospital
🇺🇸Charlotte, North Carolina, United States
Emory Johns Creek Hospital
🇺🇸Johns Creek, Georgia, United States
Baystate Health
🇺🇸Springfield, Massachusetts, United States
University of Chicago Hospitals and Clinics
🇺🇸Chicago, Illinois, United States
University of California, San Francisco
🇺🇸San Francisco, California, United States
Sioux Falls VA Medical Center
🇺🇸Sioux Falls, South Dakota, United States