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NATIONAL HARBOR, MD. – How confident are you that the medication list your patient is discharged with is completely accurate?
Dr. Jason Stein, a hospitalist at Emory University in Atlanta, said that most physicians don’t know if they’re dealing with "gold" or "garbage."
Dr. Stein, who is a mentor in the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS), said that hospitalists are often faced with either taking a "leap of faith" that the medication list is complete and accurate or throwing out the list at discharge and starting over.
MARQUIS, which was launched in 2010 by the Society of Hospital Medicine, is funded by a $1.5-million grant from the Agency for Healthcare Research and Quality. The study seeks to identify and disseminate evidence-based techniques for getting the best possible medication history from hospitalized patients with the ultimate goal of preventing medication errors. Data collection is scheduled to end this year.
The first part of the study was a literature review to cull the best available evidence on medication reconciliation practices in the hospital. That information was then used to develop a toolkit synthesizing those best practices for clinicians.
The toolkit, available online from the Society of Hospital Medicine, includes a manual on best practices and how to adapt them to individual sites, a video on how to take a good medication history, another video comparing the usual versus the optimal approach to discharge counseling, and pocket cards with questions to ask when taking a medication history.
Listen, ‘don’t lead’
"One thing that we’ve found really valuable is to not lead the witness," Dr. Jeffrey L. Schnipper, the MARQUIS principal investigator, said at the annual meeting of the Society of Hospital Medicine.
Don’t just sit there and read the medication list because the patient will likely just say yes to everything, said Dr. Schnipper, who is a hospitalist at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School in Boston. Instead, ask patients to explain what they are taking. The toolkit also provides some standard prompts to use to get patients to remember certain medications, such as ones they take only once a week or medications that are over the counter.
"You will learn a lot more," Dr. Schnipper said. "You will learn about the discrepancies that are really there and you will also be able to assess the patient’s knowledge."
The mentor method
Another big piece of MARQUIS is a mentored implementation project across six hospitals. The mentored implementation was kicked off about a year and a half ago, and the sites are now actively experimenting with interventions aimed at decreasing the number of unintentional medication discrepancies among their noncritical medical and surgical patients.
Each hospital identified a local champion, typically a hospitalist, who formed an interdisciplinary quality improvement team. That team then worked with a MARQUIS mentor, a hospitalist outside the institution with experience in both quality improvement and medication safety. The mentors had monthly phone calls with each of the sites to talk about their processes, successes, and challenges. There are also two site visits built into the study.
During the study, teams at each participating site chose from a menu of interventions recommended by the MARQUIS researchers to try to improve their medication reconciliation process. The menu includes:
• Defining medication reconciliation at their individual site.
• Assigning roles and responsibilities related to medication reconciliation.
• Improving access to preadmission medication information sources.
• Encouraging patients to keep their own up-to-date medication lists.
• Educating providers about how to take the best possible medication history.
• Implementing discharge counseling that includes patient education tools and teach back.
• Stratifying patients as low, intermediate, or high-risk based on disease state and number of medications.
• Improving information technology capability.
The sites are making progress, said Dr. Stein, who serves as a mentor to three of the six hospitals.
Presbyterian Medical Center in Charlotte already had a fairly robust program aimed at improving the medication reconciliation process. Pharmacy technicians, called medication reconciliation assistants (MRAs), are stationed in the emergency department to take a best possible medication history. The MRAs have a thorough process that includes interviewing the patient and then verifying the information with the pharmacy, the primary care physician, or the skilled nursing facility.
But they found that they were still missing patients who came in through the intensive care unit or were directly admitted. Now the center has trained a nurse to take the medication history for any patients who haven’t already seen the MRA and they’ve developed automated systems to identify those patients quickly. The hospital also created an automated system to identify high-risk patients who need a high-intensity discharge counseling session with a clinical pharmacist.
The hospital also has faced hurdles such as the fact that most of the clinicians involved in this process have never been trained on taking a thorough medication history. And even more have never received feedback on the quality of their preadmission medication histories. "This is a core competency that none of us have really ever been trained around," Dr. Stein said.
Another barrier is being clear about who is responsible for making sure each patient has an accurate medication list. "Is it the admitting provider? Unless you’ve actually explicitly outlined whose role that is, it’s nobody’s," Dr. Stein said.
The MARQUIS researchers are collecting data on the number of potentially harmful unintentional medication discrepancies per patient. The researchers collect the raw data from each of the sites and then send it on to physicians who consider the context for the discrepancies and the potential for harm.
Another goal of the project is to try to figure out why certain interventions work in certain places. The researchers are conducting surveys, interviews, direct observation, and focus groups to get these answers. "That will help us understand what components work in what settings," said MARQUIS investigator Amanda H. Salanitro, a hospitalist and health services researcher at Vanderbilt University Medical Center and the VA Tennessee Valley Healthcare System.
On Twitter @MaryEllenNY
NATIONAL HARBOR, MD. – How confident are you that the medication list your patient is discharged with is completely accurate?
Dr. Jason Stein, a hospitalist at Emory University in Atlanta, said that most physicians don’t know if they’re dealing with "gold" or "garbage."
Dr. Stein, who is a mentor in the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS), said that hospitalists are often faced with either taking a "leap of faith" that the medication list is complete and accurate or throwing out the list at discharge and starting over.
MARQUIS, which was launched in 2010 by the Society of Hospital Medicine, is funded by a $1.5-million grant from the Agency for Healthcare Research and Quality. The study seeks to identify and disseminate evidence-based techniques for getting the best possible medication history from hospitalized patients with the ultimate goal of preventing medication errors. Data collection is scheduled to end this year.
The first part of the study was a literature review to cull the best available evidence on medication reconciliation practices in the hospital. That information was then used to develop a toolkit synthesizing those best practices for clinicians.
The toolkit, available online from the Society of Hospital Medicine, includes a manual on best practices and how to adapt them to individual sites, a video on how to take a good medication history, another video comparing the usual versus the optimal approach to discharge counseling, and pocket cards with questions to ask when taking a medication history.
Listen, ‘don’t lead’
"One thing that we’ve found really valuable is to not lead the witness," Dr. Jeffrey L. Schnipper, the MARQUIS principal investigator, said at the annual meeting of the Society of Hospital Medicine.
Don’t just sit there and read the medication list because the patient will likely just say yes to everything, said Dr. Schnipper, who is a hospitalist at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School in Boston. Instead, ask patients to explain what they are taking. The toolkit also provides some standard prompts to use to get patients to remember certain medications, such as ones they take only once a week or medications that are over the counter.
"You will learn a lot more," Dr. Schnipper said. "You will learn about the discrepancies that are really there and you will also be able to assess the patient’s knowledge."
The mentor method
Another big piece of MARQUIS is a mentored implementation project across six hospitals. The mentored implementation was kicked off about a year and a half ago, and the sites are now actively experimenting with interventions aimed at decreasing the number of unintentional medication discrepancies among their noncritical medical and surgical patients.
Each hospital identified a local champion, typically a hospitalist, who formed an interdisciplinary quality improvement team. That team then worked with a MARQUIS mentor, a hospitalist outside the institution with experience in both quality improvement and medication safety. The mentors had monthly phone calls with each of the sites to talk about their processes, successes, and challenges. There are also two site visits built into the study.
During the study, teams at each participating site chose from a menu of interventions recommended by the MARQUIS researchers to try to improve their medication reconciliation process. The menu includes:
• Defining medication reconciliation at their individual site.
• Assigning roles and responsibilities related to medication reconciliation.
• Improving access to preadmission medication information sources.
• Encouraging patients to keep their own up-to-date medication lists.
• Educating providers about how to take the best possible medication history.
• Implementing discharge counseling that includes patient education tools and teach back.
• Stratifying patients as low, intermediate, or high-risk based on disease state and number of medications.
• Improving information technology capability.
The sites are making progress, said Dr. Stein, who serves as a mentor to three of the six hospitals.
Presbyterian Medical Center in Charlotte already had a fairly robust program aimed at improving the medication reconciliation process. Pharmacy technicians, called medication reconciliation assistants (MRAs), are stationed in the emergency department to take a best possible medication history. The MRAs have a thorough process that includes interviewing the patient and then verifying the information with the pharmacy, the primary care physician, or the skilled nursing facility.
But they found that they were still missing patients who came in through the intensive care unit or were directly admitted. Now the center has trained a nurse to take the medication history for any patients who haven’t already seen the MRA and they’ve developed automated systems to identify those patients quickly. The hospital also created an automated system to identify high-risk patients who need a high-intensity discharge counseling session with a clinical pharmacist.
The hospital also has faced hurdles such as the fact that most of the clinicians involved in this process have never been trained on taking a thorough medication history. And even more have never received feedback on the quality of their preadmission medication histories. "This is a core competency that none of us have really ever been trained around," Dr. Stein said.
Another barrier is being clear about who is responsible for making sure each patient has an accurate medication list. "Is it the admitting provider? Unless you’ve actually explicitly outlined whose role that is, it’s nobody’s," Dr. Stein said.
The MARQUIS researchers are collecting data on the number of potentially harmful unintentional medication discrepancies per patient. The researchers collect the raw data from each of the sites and then send it on to physicians who consider the context for the discrepancies and the potential for harm.
Another goal of the project is to try to figure out why certain interventions work in certain places. The researchers are conducting surveys, interviews, direct observation, and focus groups to get these answers. "That will help us understand what components work in what settings," said MARQUIS investigator Amanda H. Salanitro, a hospitalist and health services researcher at Vanderbilt University Medical Center and the VA Tennessee Valley Healthcare System.
On Twitter @MaryEllenNY
NATIONAL HARBOR, MD. – How confident are you that the medication list your patient is discharged with is completely accurate?
Dr. Jason Stein, a hospitalist at Emory University in Atlanta, said that most physicians don’t know if they’re dealing with "gold" or "garbage."
Dr. Stein, who is a mentor in the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS), said that hospitalists are often faced with either taking a "leap of faith" that the medication list is complete and accurate or throwing out the list at discharge and starting over.
MARQUIS, which was launched in 2010 by the Society of Hospital Medicine, is funded by a $1.5-million grant from the Agency for Healthcare Research and Quality. The study seeks to identify and disseminate evidence-based techniques for getting the best possible medication history from hospitalized patients with the ultimate goal of preventing medication errors. Data collection is scheduled to end this year.
The first part of the study was a literature review to cull the best available evidence on medication reconciliation practices in the hospital. That information was then used to develop a toolkit synthesizing those best practices for clinicians.
The toolkit, available online from the Society of Hospital Medicine, includes a manual on best practices and how to adapt them to individual sites, a video on how to take a good medication history, another video comparing the usual versus the optimal approach to discharge counseling, and pocket cards with questions to ask when taking a medication history.
Listen, ‘don’t lead’
"One thing that we’ve found really valuable is to not lead the witness," Dr. Jeffrey L. Schnipper, the MARQUIS principal investigator, said at the annual meeting of the Society of Hospital Medicine.
Don’t just sit there and read the medication list because the patient will likely just say yes to everything, said Dr. Schnipper, who is a hospitalist at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School in Boston. Instead, ask patients to explain what they are taking. The toolkit also provides some standard prompts to use to get patients to remember certain medications, such as ones they take only once a week or medications that are over the counter.
"You will learn a lot more," Dr. Schnipper said. "You will learn about the discrepancies that are really there and you will also be able to assess the patient’s knowledge."
The mentor method
Another big piece of MARQUIS is a mentored implementation project across six hospitals. The mentored implementation was kicked off about a year and a half ago, and the sites are now actively experimenting with interventions aimed at decreasing the number of unintentional medication discrepancies among their noncritical medical and surgical patients.
Each hospital identified a local champion, typically a hospitalist, who formed an interdisciplinary quality improvement team. That team then worked with a MARQUIS mentor, a hospitalist outside the institution with experience in both quality improvement and medication safety. The mentors had monthly phone calls with each of the sites to talk about their processes, successes, and challenges. There are also two site visits built into the study.
During the study, teams at each participating site chose from a menu of interventions recommended by the MARQUIS researchers to try to improve their medication reconciliation process. The menu includes:
• Defining medication reconciliation at their individual site.
• Assigning roles and responsibilities related to medication reconciliation.
• Improving access to preadmission medication information sources.
• Encouraging patients to keep their own up-to-date medication lists.
• Educating providers about how to take the best possible medication history.
• Implementing discharge counseling that includes patient education tools and teach back.
• Stratifying patients as low, intermediate, or high-risk based on disease state and number of medications.
• Improving information technology capability.
The sites are making progress, said Dr. Stein, who serves as a mentor to three of the six hospitals.
Presbyterian Medical Center in Charlotte already had a fairly robust program aimed at improving the medication reconciliation process. Pharmacy technicians, called medication reconciliation assistants (MRAs), are stationed in the emergency department to take a best possible medication history. The MRAs have a thorough process that includes interviewing the patient and then verifying the information with the pharmacy, the primary care physician, or the skilled nursing facility.
But they found that they were still missing patients who came in through the intensive care unit or were directly admitted. Now the center has trained a nurse to take the medication history for any patients who haven’t already seen the MRA and they’ve developed automated systems to identify those patients quickly. The hospital also created an automated system to identify high-risk patients who need a high-intensity discharge counseling session with a clinical pharmacist.
The hospital also has faced hurdles such as the fact that most of the clinicians involved in this process have never been trained on taking a thorough medication history. And even more have never received feedback on the quality of their preadmission medication histories. "This is a core competency that none of us have really ever been trained around," Dr. Stein said.
Another barrier is being clear about who is responsible for making sure each patient has an accurate medication list. "Is it the admitting provider? Unless you’ve actually explicitly outlined whose role that is, it’s nobody’s," Dr. Stein said.
The MARQUIS researchers are collecting data on the number of potentially harmful unintentional medication discrepancies per patient. The researchers collect the raw data from each of the sites and then send it on to physicians who consider the context for the discrepancies and the potential for harm.
Another goal of the project is to try to figure out why certain interventions work in certain places. The researchers are conducting surveys, interviews, direct observation, and focus groups to get these answers. "That will help us understand what components work in what settings," said MARQUIS investigator Amanda H. Salanitro, a hospitalist and health services researcher at Vanderbilt University Medical Center and the VA Tennessee Valley Healthcare System.
On Twitter @MaryEllenNY
AT HOSPITAL MEDICINE 13
