Elsevier

Academic Pediatrics

Volume 9, Issue 5, September–October 2009, Pages 360-365.e1
Academic Pediatrics

Tobacco Control, Inpatient Medication Discrepancies, Child Care Health and Safety
Prevalence and Clinical Significance of Medication Discrepancies at Pediatric Hospital Admission

https://doi.org/10.1016/j.acap.2009.04.007Get rights and content

Objective

To quantify admission medication discrepancies in a tertiary-care, general pediatric population, to describe their clinical importance and associated factors, and to assess a screening approach to pharmacist involvement.

Methods

A total of 272 patients were studied prospectively at hospital admission. The study pharmacist performed a medication history and compared it to physicians' admission medication orders. Discrepancies between the 2 were coded as intentional but undocumented or unintentional. Unintentional discrepancies were rated for potential to cause harm by 3 physicians. Additional data collected included patients' reason for admission and presence of chronic conditions, whether physicians used a medication reconciliation form, the characteristics of patients' home medication regimen, and the time required to perform a pharmacist history and reconciliation. Interrater reliability and associations between baseline characteristics and discrepancy rates were explored.

Results

Eighty patients (30%) had at least one undocumented intentional discrepancy (range, 0–7). At least one unintentional discrepancy (range, 0–9) was found in 59 patients (22%). Of the unintentional discrepancies, 23% had moderate and 6% had severe potential to cause discomfort or deterioration. Ratings were similar among the 3 physicians. Characteristics associated with higher risk of clinically important discrepancies were: use of the medication reconciliation form, ≥4 prescription medications, and antiepileptic drug use. Logistic regression revealed that only the variable ≥4 medications was independently associated with clinically important discrepancies.

Conclusions

Admission medication errors are common in this tertiary-care, general pediatric population, and nearly a third represent potential adverse events. The use of a medication reconciliation form by physicians without pharmacist involvement does not appear to reduce errors. A cutoff of ≥4 prescription medications is highly sensitive for identifying patients at risk of clinically important discrepancies.

Section snippets

Setting

This is a prevalence study on a consecutive sample of general pediatric admissions that uses methodology described by Cornish and colleagues.4 The setting was a 60-bed general pediatrics unit within a 300-bed tertiary-care children's hospital in Toronto, Canada. Approximately 90% of admissions to the unit come from the emergency department. The unit is staffed by a combination of traditional teaching teams consisting of students, residents, and faculty as well as hospitalist-only teams, with

Results

During the study period, 356 admissions were identified by the study pharmacist (Figure). Forty (11%) were not approached, either as a result of lack of availability of the study pharmacist within 24 hours (n = 21) or due to patient factors (n = 19), the most common of which was lack of an available parent/guardian despite repeated attempts to make contact in person and by phone (n = 12). Thus, of the 356 admissions, 316 patients (89%) were approached. Of these, 21 were excluded (discharged within 24 

Discussion

Our findings demonstrate that medication errors at admission are common in this general pediatric population, and the sample was large enough to detect highly significant differences in discrepancy rates. The high degree of agreement among the physicians supports this method as a valid measure of the clinical importance of unintentional discrepancies. In contrast to previous studies of similar methodology, the severity ratings were performed by authors unaffiliated with the study, who are

Acknowledgments

This study was funded by Paediatric Consultants, The Hospital for Sick Children, Toronto, Ontario, Canada (principal investigator, Maitreya Coffey). We thank Dr Gideon Koren for his review of the manuscript and Christina Stevancec for assistance with manuscript preparation.

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