The clinical significance of medicines reconciliation in children admitted to hospital

Chi Huynh, David Terry, Stephen Tomlin, Yogini Jani, Helen Haley, Rachel Smith, Andrew Lowey, Anthony Sinclair, Keith Wilson, Ian Chi Kei Wong

Research output: Contribution to journalMeeting abstract

Abstract

Aims and Objectives: The NICE/NPSA guidance on Medicines Reconciliation in adults upon hospital admission excludes children under the age of 16.1 Hence the primary aim and objective of this study was to use medicines reconciliation to primarily identify if discrepancies occur upon hospital admission. Secondary objectives were to clinically assess for harm discrepancies that were identified in paediatric patients on long term medications at four hospitals across the UK.
Method: Medicines reconciliation is a procedure where the current medication history of a patient prior to hospital admission would be taken and verifying the medication orders made at hospital admission against this history, addressing any discrepancies identified. Medicines reconciliation was carried out prospectively for 244 paediatric patients on chronic medication across four UK hospitals (Birmingham, London, Leeds and North Staffordshire) between January – May 2011. Medicines reconciliation was conducted by a clinical pharmacist using the following sources of information: 1) the patient's Pre-Admission Medication (PAM) from the patient's general practitioner 2) examination of the Patient's Own Medications brought into hospital, 3) a semi-structured interview with the parent-carers and 4) identification of admission medication orders written on the drug chart prior to clinical pharmacy input (Drug Chart). Discrepancies between the PAM and Drug Chart were documented and classified as intentional or unintentional. Intentional discrepancies were defined as changes that were made knowingly by the prescriber and confirmed. Unintentional discrepancies were assessed for clinical significance by an expert panel and assigned a significance score based on the likelihood of causing potential discomfort or clinical deterioration: class 1 unlikely, class 2 moderate and class 3 severe.2
Results: 1004 medication regimens were included from the 244 patients across the four sites. 588 of the 1004 (59%) medicines, had discrepancies between the PAM and Drug Chart; of these 36% (n = 209) were unintentional and included for clinically assessment. 189 drug discrepancies 30% were classified as class 1, 47% were class 2 and 23% were class 3 discrepancies. The remaining 20 discrepancies were cases where deviating from the PAM would have been the right thing to do, which might suggest that an intentional but undocumented discrepancy by the prescriber writing up the admission order may have occurred.
Conclusion:
The results suggest that medication discrepancies in paediatric patients do occur upon hospital admission, which do have a potential to cause harm and that medicines reconciliation is a potential solution to preventing such discrepancies.
References:
1. National Institute for Health and Clinical Excellence. National Patient Safety Agency. PSG001. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London: NICE; 2007.
2. Cornish, P. L., Knowles, S. R., Marchesano, et al. Unintended Medication Discrepancies at the Time of Hospital Admission. Archives of Internal Medicine 2005; 165:424–429
Original languageEnglish
Pages (from-to)792
Number of pages1
JournalPharmacoepidemiology and Drug Safety
Volume21
Issue number7
DOIs
Publication statusPublished - Jul 2012
EventPrescribing and Research in Medicines (UK & Ireland) Conference 2012: Seamless care... or Careless Seams... Reducing medication errors at interfaces - Imperial Hotel London, London, United Kingdom
Duration: 9 Feb 2012 → …

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Clinical Medicine
Pharmaceutical Preparations
Patient Safety
Pediatrics
Patient Admission
National Institutes of Health (U.S.)
Internal Medicine
Pharmacists
General Practitioners
Caregivers
History
Medicine
Interviews

Bibliographical note

Abstracts: Prescribing and Research in Medicines (UK & Ireland) Conference 2012, Imperial Hotel London, February 9th 2012 “Seamless care... or Careless Seams... Reducing medication errors at interfaces”

Cite this

Huynh, C., Terry, D., Tomlin, S., Jani, Y., Haley, H., Smith, R., ... Wong, I. C. K. (2012). The clinical significance of medicines reconciliation in children admitted to hospital. Pharmacoepidemiology and Drug Safety, 21(7), 792. https://doi.org/10.1002/pds.3262
Huynh, Chi ; Terry, David ; Tomlin, Stephen ; Jani, Yogini ; Haley, Helen ; Smith, Rachel ; Lowey, Andrew ; Sinclair, Anthony ; Wilson, Keith ; Wong, Ian Chi Kei. / The clinical significance of medicines reconciliation in children admitted to hospital. In: Pharmacoepidemiology and Drug Safety. 2012 ; Vol. 21, No. 7. pp. 792.
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title = "The clinical significance of medicines reconciliation in children admitted to hospital",
abstract = "Aims and Objectives: The NICE/NPSA guidance on Medicines Reconciliation in adults upon hospital admission excludes children under the age of 16.1 Hence the primary aim and objective of this study was to use medicines reconciliation to primarily identify if discrepancies occur upon hospital admission. Secondary objectives were to clinically assess for harm discrepancies that were identified in paediatric patients on long term medications at four hospitals across the UK.Method: Medicines reconciliation is a procedure where the current medication history of a patient prior to hospital admission would be taken and verifying the medication orders made at hospital admission against this history, addressing any discrepancies identified. Medicines reconciliation was carried out prospectively for 244 paediatric patients on chronic medication across four UK hospitals (Birmingham, London, Leeds and North Staffordshire) between January – May 2011. Medicines reconciliation was conducted by a clinical pharmacist using the following sources of information: 1) the patient's Pre-Admission Medication (PAM) from the patient's general practitioner 2) examination of the Patient's Own Medications brought into hospital, 3) a semi-structured interview with the parent-carers and 4) identification of admission medication orders written on the drug chart prior to clinical pharmacy input (Drug Chart). Discrepancies between the PAM and Drug Chart were documented and classified as intentional or unintentional. Intentional discrepancies were defined as changes that were made knowingly by the prescriber and confirmed. Unintentional discrepancies were assessed for clinical significance by an expert panel and assigned a significance score based on the likelihood of causing potential discomfort or clinical deterioration: class 1 unlikely, class 2 moderate and class 3 severe.2Results: 1004 medication regimens were included from the 244 patients across the four sites. 588 of the 1004 (59{\%}) medicines, had discrepancies between the PAM and Drug Chart; of these 36{\%} (n = 209) were unintentional and included for clinically assessment. 189 drug discrepancies 30{\%} were classified as class 1, 47{\%} were class 2 and 23{\%} were class 3 discrepancies. The remaining 20 discrepancies were cases where deviating from the PAM would have been the right thing to do, which might suggest that an intentional but undocumented discrepancy by the prescriber writing up the admission order may have occurred.Conclusion: The results suggest that medication discrepancies in paediatric patients do occur upon hospital admission, which do have a potential to cause harm and that medicines reconciliation is a potential solution to preventing such discrepancies.References: 1. National Institute for Health and Clinical Excellence. National Patient Safety Agency. PSG001. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London: NICE; 2007.2. Cornish, P. L., Knowles, S. R., Marchesano, et al. Unintended Medication Discrepancies at the Time of Hospital Admission. Archives of Internal Medicine 2005; 165:424–429",
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Huynh, C, Terry, D, Tomlin, S, Jani, Y, Haley, H, Smith, R, Lowey, A, Sinclair, A, Wilson, K & Wong, ICK 2012, 'The clinical significance of medicines reconciliation in children admitted to hospital', Pharmacoepidemiology and Drug Safety, vol. 21, no. 7, pp. 792. https://doi.org/10.1002/pds.3262

The clinical significance of medicines reconciliation in children admitted to hospital. / Huynh, Chi; Terry, David; Tomlin, Stephen; Jani, Yogini; Haley, Helen; Smith, Rachel; Lowey, Andrew; Sinclair, Anthony; Wilson, Keith; Wong, Ian Chi Kei.

In: Pharmacoepidemiology and Drug Safety, Vol. 21, No. 7, 07.2012, p. 792.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - The clinical significance of medicines reconciliation in children admitted to hospital

AU - Huynh, Chi

AU - Terry, David

AU - Tomlin, Stephen

AU - Jani, Yogini

AU - Haley, Helen

AU - Smith, Rachel

AU - Lowey, Andrew

AU - Sinclair, Anthony

AU - Wilson, Keith

AU - Wong, Ian Chi Kei

N1 - Abstracts: Prescribing and Research in Medicines (UK & Ireland) Conference 2012, Imperial Hotel London, February 9th 2012 “Seamless care... or Careless Seams... Reducing medication errors at interfaces”

PY - 2012/7

Y1 - 2012/7

N2 - Aims and Objectives: The NICE/NPSA guidance on Medicines Reconciliation in adults upon hospital admission excludes children under the age of 16.1 Hence the primary aim and objective of this study was to use medicines reconciliation to primarily identify if discrepancies occur upon hospital admission. Secondary objectives were to clinically assess for harm discrepancies that were identified in paediatric patients on long term medications at four hospitals across the UK.Method: Medicines reconciliation is a procedure where the current medication history of a patient prior to hospital admission would be taken and verifying the medication orders made at hospital admission against this history, addressing any discrepancies identified. Medicines reconciliation was carried out prospectively for 244 paediatric patients on chronic medication across four UK hospitals (Birmingham, London, Leeds and North Staffordshire) between January – May 2011. Medicines reconciliation was conducted by a clinical pharmacist using the following sources of information: 1) the patient's Pre-Admission Medication (PAM) from the patient's general practitioner 2) examination of the Patient's Own Medications brought into hospital, 3) a semi-structured interview with the parent-carers and 4) identification of admission medication orders written on the drug chart prior to clinical pharmacy input (Drug Chart). Discrepancies between the PAM and Drug Chart were documented and classified as intentional or unintentional. Intentional discrepancies were defined as changes that were made knowingly by the prescriber and confirmed. Unintentional discrepancies were assessed for clinical significance by an expert panel and assigned a significance score based on the likelihood of causing potential discomfort or clinical deterioration: class 1 unlikely, class 2 moderate and class 3 severe.2Results: 1004 medication regimens were included from the 244 patients across the four sites. 588 of the 1004 (59%) medicines, had discrepancies between the PAM and Drug Chart; of these 36% (n = 209) were unintentional and included for clinically assessment. 189 drug discrepancies 30% were classified as class 1, 47% were class 2 and 23% were class 3 discrepancies. The remaining 20 discrepancies were cases where deviating from the PAM would have been the right thing to do, which might suggest that an intentional but undocumented discrepancy by the prescriber writing up the admission order may have occurred.Conclusion: The results suggest that medication discrepancies in paediatric patients do occur upon hospital admission, which do have a potential to cause harm and that medicines reconciliation is a potential solution to preventing such discrepancies.References: 1. National Institute for Health and Clinical Excellence. National Patient Safety Agency. PSG001. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London: NICE; 2007.2. Cornish, P. L., Knowles, S. R., Marchesano, et al. Unintended Medication Discrepancies at the Time of Hospital Admission. Archives of Internal Medicine 2005; 165:424–429

AB - Aims and Objectives: The NICE/NPSA guidance on Medicines Reconciliation in adults upon hospital admission excludes children under the age of 16.1 Hence the primary aim and objective of this study was to use medicines reconciliation to primarily identify if discrepancies occur upon hospital admission. Secondary objectives were to clinically assess for harm discrepancies that were identified in paediatric patients on long term medications at four hospitals across the UK.Method: Medicines reconciliation is a procedure where the current medication history of a patient prior to hospital admission would be taken and verifying the medication orders made at hospital admission against this history, addressing any discrepancies identified. Medicines reconciliation was carried out prospectively for 244 paediatric patients on chronic medication across four UK hospitals (Birmingham, London, Leeds and North Staffordshire) between January – May 2011. Medicines reconciliation was conducted by a clinical pharmacist using the following sources of information: 1) the patient's Pre-Admission Medication (PAM) from the patient's general practitioner 2) examination of the Patient's Own Medications brought into hospital, 3) a semi-structured interview with the parent-carers and 4) identification of admission medication orders written on the drug chart prior to clinical pharmacy input (Drug Chart). Discrepancies between the PAM and Drug Chart were documented and classified as intentional or unintentional. Intentional discrepancies were defined as changes that were made knowingly by the prescriber and confirmed. Unintentional discrepancies were assessed for clinical significance by an expert panel and assigned a significance score based on the likelihood of causing potential discomfort or clinical deterioration: class 1 unlikely, class 2 moderate and class 3 severe.2Results: 1004 medication regimens were included from the 244 patients across the four sites. 588 of the 1004 (59%) medicines, had discrepancies between the PAM and Drug Chart; of these 36% (n = 209) were unintentional and included for clinically assessment. 189 drug discrepancies 30% were classified as class 1, 47% were class 2 and 23% were class 3 discrepancies. The remaining 20 discrepancies were cases where deviating from the PAM would have been the right thing to do, which might suggest that an intentional but undocumented discrepancy by the prescriber writing up the admission order may have occurred.Conclusion: The results suggest that medication discrepancies in paediatric patients do occur upon hospital admission, which do have a potential to cause harm and that medicines reconciliation is a potential solution to preventing such discrepancies.References: 1. National Institute for Health and Clinical Excellence. National Patient Safety Agency. PSG001. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London: NICE; 2007.2. Cornish, P. L., Knowles, S. R., Marchesano, et al. Unintended Medication Discrepancies at the Time of Hospital Admission. Archives of Internal Medicine 2005; 165:424–429

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Huynh C, Terry D, Tomlin S, Jani Y, Haley H, Smith R et al. The clinical significance of medicines reconciliation in children admitted to hospital. Pharmacoepidemiology and Drug Safety. 2012 Jul;21(7):792. https://doi.org/10.1002/pds.3262