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Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation

dc.contributor.authorMixon, Amanda S.
dc.contributor.authorKripalani, Sunil
dc.contributor.authorStolldorf, Deonni
dc.identifier.citationMixon, A.S., Smith, G.R., Mallouk, M. et al. Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation. BMC Health Serv Res 19, 659 (2019).
dc.identifier.othereISSN: 1472-6963
dc.descriptionOnly Vanderbilt University affiliated authors are listed on VUIR. For a full list of authors, access the version of record at
dc.description.abstractBackground The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. Methods MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. Discussion A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.en_US
dc.description.sponsorshipThis study was supported by a grant from the Agency for Healthcare Research and Quality, R18 HS023757 (Dr. Schnipper) and in part by grant UL1 RR024975-01 from the National Center for Research Resources and grant 2 UL1 TR000445-06 from the National Center for Advancing Translational Sciences. Dr. Mixon was funded by a VA HSR&D Career Development Award (12-168). Dr. Stolldorf was funded by grant K01HS025486 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The funding agency was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. All authors had full access to the data.en_US
dc.rightsOpen Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
dc.subjectMedication reconciliationen_US
dc.subjectPatient safetyen_US
dc.subjectHospital medicineen_US
dc.subjectTransitions in careen_US
dc.subjectMedication errorsen_US
dc.subjectQuality improvementen_US
dc.titleDesign of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliationen_US

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