Approximately 50% of patients in U.S. hospitals experience at least 1 unintentional medication discrepancy and 52% of these discrepancies have the potential for significant harm. Medication reconciliation (MedRec) can reduce the number of medication discrepancies by more than 60%. However, the complexity and contextual barriers associated with MedRec have stunted implementation, and best practices to foster effective implementation and sustainability remain largely unknown. Published MedRec studies usually have an inadequate description of the implementation methods and the contextual factors driving their selection. A lack of both long-term outcome studies and valid measures of sustainability have further limited our understanding of how to best sustain effective MedRec interventions. Identifying how implementation strategies and contextual factors (i.e., capacity, leadership, goal alignment, climate, readiness for change, and team cohesion) predict sustainability and long-term effectiveness of MedRec interventions, would provide important guidance for hospitals nationally and improve patient safety. This proposal describes a career development plan that enables the candidate to gain expertise in advanced research methods and implementation science, through mentored research and didactic training. It leverages the AHRQ-funded, ?Implementation of a Medication Reconciliation Protocol to Improve Patient Safety,? study (MARQUIS2, R18 HS023757), which is investigating MedRec in 18 diverse U.S. hospitals, and provides a unique opportunity to study organizational context and sustainability at these facilities.
The Specific Aims are: 1) Describe implementation strategies and examine their association with contextual factors; 2) Develop and validate a sustainability measure; and, 3) Investigate the relationship of contextual factors and implementation strategies with the sustainability of MedRec interventions. The candidate is highly qualified as a PhD prepared nurse who has studied sustainability in other contexts. The career development plan builds on this foundation to provide: a) advanced skills in research methods (e.g., focus groups and multi-level modeling), implementation science, and instrument development; b) scientific writing skills through manuscript preparation and grant writing; and, c) an interdisciplinary mentored research experience with experts in implementation research. The institutional environment is exceptional, including research centers in implementation research and qualitative methods. This career development award will allow the candidate to develop a deep understanding of implementation methods and expertise in measurement to study the sustainability of complex, interdisciplinary interventions in healthcare organizations. This award will position the candidate to become an R01-funded independent investigator who develops evidence-based implementation practices for optimizing the sustainability of complex healthcare interventions to improve patient safety and quality of care.
More than 3.8 million patients experience a serious preventable medication error during inpatient admissions in U.S. hospitals, with 66% of errors occurring during transitions of care. Despite medication reconciliation reducing medication discrepancies during transitions of care by more than 60%, implementation has been difficult and little is known about medication reconciliation sustainability in U.S. hospitals. This study will examine the impact of organizational context and the strategies that leaders use to implement the complex interdisciplinary healthcare intervention of medication reconciliation on the outcomes of medication reconciliation sustainability and unintentional medication discrepancies.
