Research finds greatest methods to scale back the variety of remedy discrepancies in hospitals
A brand new examine from researchers from Brigham and Girls’s Hospital, a founding member of the Mass Common Brigham healthcare system, has shed new gentle on the very best methods hospitals can use for remedy reconciliation, the crucial and tough activity of updating and verifying a affected person’s remedy lists and orders, no matter the place they’re within the well being care system. The examine, printed in BMJ High quality and Security, is a brand new evaluation of knowledge from the second Multi-center Medicine Reconciliation High quality Enchancment Research (MARQUIS2).
“We discovered that taking a ‘absolute best’ remedy historical past whereas the affected person continues to be within the emergency division is way more efficient than taking it later when the affected person has already been admitted to the hospital,” stated corresponding writer Jeffrey L. Schnipper, MD, MPH, Analysis Director of the Brigham’s Division of Common Inner Drugs and Major Care, a professor of medication at Harvard Medical Faculty and principal investigator of the MARQUIS2 examine. “These findings present particular steerage that hospitals and well being methods can use to enhance remedy security and shield sufferers from discrepancies.”
Whereas digital well being data have improved many features of medication, the existence of a number of digital data from completely different healthcare suppliers introduces challenges for hospitals when establishing a affected person’s full and correct remedy historical past. Medicine reconciliation is especially difficult throughout care transitions, together with admission to and discharge from the hospital. And whereas not each remedy discrepancy causes hurt, medical sufferers expertise, on common, a minimum of one probably dangerous remedy discrepancy per hospitalization.
That is a kind of areas the place individuals simply assume hospitals can at all times do it accurately, but it surely’s really fairly tough in observe. The common affected person coming to a hospital has a number of docs, is taking a number of completely different drugs, and is probably not constantly taking what they’ve been prescribed.”
Jeffrey L. Schnipper, MD, MPH, Analysis Director, Brigham’s Division of Common Inner Drugs and Major Care
Bettering remedy security has been a Nationwide Affected person Security Objective of The Joint Fee since 2005, however remedy reconciliation has confirmed a problem for hospitals, largely as a consequence of elements like restricted sources and issue implementing advanced workflows.
“Right here we’re virtually 20 years later, and we nonetheless have not fairly figured it out,” added Schnipper.
The MARQUIS2 examine was performed at 18 various hospitals in North America over 18 months, offering a toolkit and mentored implementation to enhance remedy reconciliation procedures. The examine discovered that on common, remedy discrepancies decreased by about 5% per 30 days, and by virtually two-thirds total, when the toolkit was applied. Of their new report, the researchers additional analyzed the outcomes to find out which particular interventions have been only.
They discovered that the best interventions have been taking a complete remedy historical past earlier than hospital admission, whereas sufferers are nonetheless within the emergency division, and reconciling drugs upon discharge by evaluating regimens previous to admission, in the course of the hospitalization, and in discharge orders.
“We have to get hospitals targeted on taking the absolute best remedy historical past within the emergency division, after which doing good discharge medication reconciliation on high of that, particularly for the best danger sufferers,” stated Schnipper. “Supporting these two efforts would go a good distance towards bettering affected person security.”
Whereas the MARQUIS2 examine has helped begin the method, the researchers acknowledge that it’s going to take extra analysis to completely deal with the advanced points that affect remedy security.
“What we’ve carried out up to now applies to hospitals, the place we all know individuals are on a variety of drugs, however there are different care settings the place remedy discrepancies happen,” stated Schnipper. “A few of our subsequent steps are to have a look at outpatient settings, like physician’s workplaces, in addition to double transitions, the place a affected person spends time in one other facility similar to rehabilitation earlier than going dwelling.”
Within the quick time period, the researchers have made the MARQUIS2 toolkit accessible for free of charge to hospitals and are offering session to hospitals to assist information them by way of the method of implementation.
“We need to scale this up as a lot as potential, to as many hospitals which might be prepared for it,” stated Schnipper. “That’s the place we will make the largest rapid affect.”
Brigham and Girls’s Hospital
Schnipper, J. L., et al. (2023). What works in remedy reconciliation: an on-treatment and website evaluation of the MARQUIS2 examine. BMJ High quality & Security. doi.org/10.1136/bmjqs-2022-014806.