Improving Medication Safety During Care Transitions

"With support from AHRQ, I have identified high-tech solutions that optimize care delivery during transitions. Hospitals can implement these best practices, including medication safety interventions, to achieve measurable improvements in patient safety."

From the earliest stages of his career, Jeffrey Schnipper, M.D., M.P.H., has been focused on improving healthcare delivery, particularly during transitions in care. “As patients move from one location to another, information about their care needs to be conveyed accurately,” according to Dr. Schnipper, who directs research and cares for patients at Brigham and Women’s Hospital in Boston.

"As a hospitalist, it was very clear that a lot of our patients were having issues around transitions in care and that it was important to come up with delivery solutions to bridge that gap," said Dr. Schnipper, who is also a professor of medicine at Harvard Medical School. With support from AHRQ over the past two decades, he has been able to address his goal of improving care delivery, particularly around medication safety issues.

Medication safety errors are among the most common adverse events in healthcare. One technique to prevent these kinds of problems is medication reconciliation, which means ensuring that medications are checked as patients move from one location to another to prevent unintended mistakes. To address this problem, Dr. Schnipper initiated the AHRQ-funded Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) at five hospitals in 2010.

The initial study identified ways to check prescription accuracy and adherence, evaluate the interventions, and disseminate results so that the learning could be shared with others. “This research filled a critical need, as rigorously designed studies comparing medication reconciliation practices were scarce at that time,” said Dr. Schnipper. The study produced important insights on medication reconciliation best practices, for example, finding that hospitals should hire and train pharmacy staff to assist with medication reconciliation at discharge. A toolkit was developed based on the study’s findings to help other facilities implement these best practices.

Dr. Schnipper built on this research by conducting a larger, more diverse study on medication reconciliation approaches, known as MARQUIS2. Through this AHRQ-funded project, Dr. Schnipper further refined his initial toolkit and implemented it at 18 hospitals. This follow-on study evaluated the toolkit’s effects on unintentional medication discrepancies in admission and discharge orders using methods developed over several studies. The resulting MARQUIS2 toolkit provides a scalable and testable approach that can be widely implemented across institutions to improve medication safety during transitions in care.

Dr. Schnipper also received AHRQ funding to develop, implement, and evaluate health information technology (HIT) tools that facilitate medication reconciliation. One example is a smart pill box for patients discharged from the hospital to the community. The pill box decreases medication discrepancies by comparing dispensed medications against the regimen documented in the electronic health record, and it tracks medication use each time medications are removed from the pill box. The tool contains pre-filled medication trays and offers HIT features to facilitate adherence, including the ability to send alerts to patients or caregivers by phone, email, or text if medication trays are not accessed. The pill box also generates adherence reports to help monitor compliance. “HIT tools such as the smart pill box can play an instrumental role in medication reconciliation best practices as they automate processes to produce immediate results and remove the chance of human error,” Dr. Schnipper explains.

In addition to his work as a health services researcher, Dr. Schnipper serves as a mentor for new patient safety researchers participating in AHRQ’s career development awards program. He is a member of the American College of Physicians, American Medical Informatics Association, Massachusetts Medical Society, Society of General Internal Medicine, and Society of Hospital Medicine. Dr. Schnipper received the Society of Hospital Medicine Excellence in Research Award, as well as multiple employee awards recognizing his excellent work as an internist and hospitalist at Brigham and Women's Hospital.

Principal Investigator: Jeffrey Schnipper, M.D., M.P.H.
Institution: Brigham and Women’s Hospital and Harvard Medical School
Grantee Since: 2010
Type of Grant: Various

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