Multi-Center Medication Reconciliation Quality Improvement Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,836
- 试验地点
- 12
- 主要终点
- The primary outcome will be unintentional medication discrepancies in admission orders and discharge orders with potential for patient harm
研究概览
简要总结
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.
详细描述
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
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18 and over
- •Admitted to inpatient medical or surgical services
排除标准
- •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.
研究组 & 干预措施
Pre-intervention
Usual care regarding medication reconciliation as currently practiced at each participating site.
Intervention
Improved medication reconciliation process using continuous quality improvement methods, mentored implementation, and an implementation guide.
干预措施: Mentored medication reconciliation quality improvement (Other)
结局指标
主要结局
The primary outcome will be unintentional medication discrepancies in admission orders and discharge orders with potential for patient harm
时间窗: 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.
次要结局
- Patient satisfaction(6 months prior to implementation of intervention to 21 months during intervention)
- Total medication discrepancies(6 months prior to implementation of intervention to 21 months during intervention)
- Administrative outcomes(6 months prior to implementation of intervention to 21 months during intervention)
研究者
Jeffrey L. Schnipper, MD.,MPH.
Associate Professor of Medicine
Brigham and Women's Hospital