Search

BackgroundThe 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.MethodsMARQUIS2 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.DiscussionA 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.

Personal age (how old a person seems to himself) is proposed (a) as a potential component of total functional age and (b) as a basis of classification in attempts to create and modify “old behavior.” Companion constructs are those of interpersonal age (how old a person seems to others) and consensual age (degree of agreement between personal and interpersonal ages). Illustrative data are reported from a sample of 75 adults (38 women, 37 men) who range in age from 20 to 69; 43 are enrolled in advanced gerontology training programs. The results suggest that personal age is comprised of at least two fairly distinct components: how old S looks and how old he feels. There is a strong bias toward reporting personal age as more youthful than chronological age—a bias that becomes more pronounced with advancing chronological age level. All of the age constructs are related to chronological age, although not always in a linear or simple manner. At this point in the research program, gerontology specialists do not appear conspicuously different from nongerontologists in their response to personal age and other related questions.