Table 1.

Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) Toolkit Components^*

A. First Steps for Success: Preparation and Site Assessment	Examples
Review of Basic Quality Improvement Principles Additional materials available in Appendix (1, 2)	▪ Start preimplementation planning ▪ Clarify key stakeholders ▪ Obtain institutional support
Define Steps of Medication Reconciliation process	▪ Take BPMH on admission ▪ Reconcile BPMH with admission orders ▪ At time of transfer or discharge, reconcile BPMH and current medication orders ▪ At discharge, provide discharge medication counseling to the patient and an accurate medication list to patient/caregiver ▪ At discharge, communicate medication list with outpatient provider
Brief Literature Review	▪ Referenced†
Assemble Team and Develop a Strategy	▪ Identify team members, including team leader, QI team facilitator, etc. ▪ Map current medication reconciliation process, perform gap analysis ▪ Create specific, measurable goals
B. Intervention Components	Examples
I. Assigning Roles and Responsibilities	▪ Identify resources available for each person to complete task ▪ Outline required knowledge, skills, and behaviors for person performing each med reconciliation step ▪ Encourage ideal use of personnel to increase efficiency ▪ Assign “ownership” for the overall medication reconciliation process
II. Improve Access to Preadmission Medication Sources	▪ Empower patients/caregivers to own medication list ▪ Improve skills of inpatient medication history-takers ▪ Improve IT access to sources of medication information
III. Patient-Owned Medication Lists  Additional materials available in Appendix 4	▪ Provide patient with templated medication list on discharge ▪ Provide patients with medication lists in the ambulatory setting to support admission list creation
IV. Guidelines for Taking a BPMH  Instructional video available  Additional materials available in Appendix (3, 4)	▪ Use at least two different sources of information in compiling BPMH (for example, patient, medication list, pharmacy, etc.) ▪ Resolve any discrepancies between sources ▪ Use probing questions
V. Discharge Counseling  Instructional video available  Additional materials available in Appendix (4)	▪ Correctly identify the “active learner” ▪ Review the entire medication list, including new meds, changes and discontinued meds, instructions, and potential side effects ▪ Use the “teach-back” technique
VI. Risk Stratification	▪ Stratify patients into high vs. low-intermediate risk based on patient characteristics (for example, number of preadmission medications, etc.) such that high-risk patients receive additional resources (see VII.)
VII. Use of Medication Reconciliation Bundle  Additional materials available in Appendix (6, 7)	▪ Ensure that high-risk patients have medication histories obtained from and medication counseling performed by the most highly skilled personnel with time and resources to perform an “intensive” medication reconciliation bundle
VIII. Application of IT, Ideal Features  Additional materials available in Appendix (7)	▪ Increase access to sources of preadmission medication information ▪ Facilitate comparison and reconciliation of medication lists
IX. Phased Implementation	▪ Phase in interventions by location or service, patient risk, or component
X. Social Marketing/Engagement of Community  Additional materials available in Appendix (8)	▪ Determine target audience (for example, inpatient or outpatient providers, patients)
C. Appendix (Supplemental Material)	Examples
1. Making Business Case for Medication Reconciliation	▪ Demonstrate potential for return on investment
2. MARQUIS Institutional Site Assessment	▪ Assess institutional support ▪ Assess existence of on-site study pharmacist ▪ Assess policies and procedures for medication reconciliation
3. Best Possible Medication History (BPMH) Toolkit	▪ Case for role-play
4. Patient-Friendly Discharge Material	▪ Examples provided
5. Patient-Owned Medication Lists	▪ Adopt a medication template, provide patient/caregiver with template on discharge
6. Paper Medication Reconciliation Forms	▪ Examples provided
7. Vendors of Electronic Medication Reconciliation Products	▪ Examples provided
8. Social Marketing Materials	▪ Examples provided

^*Appendices refer to those available with the implementation manual at Society of Hospital Medicine. Overview: Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS). Accessed Jun 27, 2013. http://www.hospitalmedicine.org/MARQUIS. BPMH, best possible medication history; QI, quality improvement; IT, information technology.

^†Mueller SK, et al. Hospital-based medication reconciliation practices: A systematic review. Arch Intern Med. 2012 Jul 23;172(14):1057–1069.