dc.contributor.author | Presley, Caroline A. | |
dc.contributor.author | Wooldridge, Kathleene T. | |
dc.contributor.author | Byerly, Susan H. | |
dc.contributor.author | Aylor, Amy R. | |
dc.contributor.author | Kaboli, Peter J. | |
dc.contributor.author | Roumie, Christianne L. | |
dc.contributor.author | Schnipper, Jeffrey L. | |
dc.contributor.author | Dittus, Robert S. | |
dc.contributor.author | Mixon, Amanda S. | |
dc.date.accessioned | 2020-09-24T02:37:20Z | |
dc.date.available | 2020-09-24T02:37:20Z | |
dc.date.issued | 2020-01-15 | |
dc.identifier.citation | Caroline A Presley, M.D., M.P.H, Kathleene T Wooldridge, M.D., M.P.H, Susan H Byerly, A.S, Amy R Aylor, Pharm.D, Peter J Kaboli, M.D., M.S., FACP, FHM, Christianne L Roumie, M.D., M.P.H, Jeffrey L Schnipper, M.D., M.P.H., FHM, Robert S Dittus, M.D., M.P.H, Amanda S Mixon, M.D., M.S., M.S.P.H., FHM, The Rural VA Multi-Center Medication Reconciliation Quality Improvement Study (R-VA-MARQUIS), American Journal of Health-System Pharmacy, Volume 77, Issue 2, 15 January 2020, Pages 128–137, https://doi.org/10.1093/ajhp/zxz275 | en_US |
dc.identifier.issn | 1079-2082 | |
dc.identifier.uri | http://hdl.handle.net/1803/16147 | |
dc.description.abstract | Purpose High-quality medication reconciliation reduces medication discrepancies, but smaller hospitals serving rural patients may have difficulty implementing this because of limited resources. We sought to adapt and implement an evidence-based toolkit of best practices for medication reconciliation in smaller hospitals, evaluate the effect on unintentional medication discrepancies, and assess facilitators and barriers to implementation.
Methods We conducted a 2-year mentored-implementation quality improvement feasibility study in 3 Veterans Affairs (VA) hospitals serving rural patients. The primary outcome was unintentional medication discrepancies per medication per patient, determined by comparing the "gold standard" preadmission medication history to the documented preadmission medication list and admission and discharge orders.
Results In total, 797 patients were included; their average age was 68.7 years, 94.4% were male, and they were prescribed an average of 9.6 medications. Sites 2 and 3 implemented toolkit interventions, including clarifying roles among clinical personnel, educating providers on taking a best possible medication history, and hiring pharmacy professionals to obtain a best possible medication history and perform discharge medication reconciliation. Site 1 did not implement an intervention. Discrepancies improved in intervention patients compared with controls at Site 3 (adjusted incidence rate ratio [IRR], 0.55; 95% confidence interval [CI], 0.45-0.67) but increased in intervention patients compared with controls at Site 2 (adjusted IRR, 1.22; 95% CI, 1.08-1.36).
Conclusions An evidence-based toolkit for medication reconciliation adapted to the VA setting was adopted in 2 of 3 small, rural, resource-limited hospitals, resulting in both reduced and increased unintentional medication discrepancies. We highlight facilitators and barriers to implementing evidence-based medication reconciliation in smaller hospitals. | en_US |
dc.description.sponsorship | This work was supported by the VA Office of Rural Health (N32-FY15Q1-S1-P01535); VA HSR&D Career Development Award (12168 to ASM); VA National Quality Scholars Program, Office of Academic Affiliations, Department of Veterans Affairs. | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | American Journal of Health-System Pharmacy | en_US |
dc.rights | Published by Oxford University Press
on behalf of the American Society of
Health-System Pharmacists 2020. This
work is written by (a) US Government
employee(s) and is in the public domain
in the US. | |
dc.source.uri | https://academic.oup.com/ajhp/article/77/2/128/5698129 | |
dc.subject | hospital medicine | en_US |
dc.subject | medication reconciliation | en_US |
dc.subject | patient safety | en_US |
dc.subject | quality improvement | en_US |
dc.subject | rural health | en_US |
dc.subject | veterans | en_US |
dc.title | The Rural VA Multi-Center Medication Reconciliation Quality Improvement Study (R-VA-MARQUIS) | en_US |
dc.type | Article | en_US |
dc.identifier.doi | 10.1093/ajhp/zxz275 | |