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Hospital admission medication reconciliation in medically complex children: an observational study.
Arch Dis Child 2010; 95(4):250-5AD

Abstract

OBJECTIVE

To evaluate admission medication reconciliation in children with medically complex conditions (MCC) by determining the availability and accuracy of five information sources and characterising admitting order errors.

DESIGN

Prospective quality improvement cohort study.

SETTING

Tertiary care free-standing children's hospital in the Intermountain west, USA.

PARTICIPANTS

23 children with MCC identified from 219 admissions between 16 December 2004 and 7 January 2005.

INTERVENTION

Medication reconciliation at hospital admission using information from five sources.

MAIN OUTCOMES

The accuracy of information sources was determined by sensitivity and specificity compared with verified outpatient medication lists. Errors were determined by comparing admitting orders with reconciled inpatient medication lists and categorised by frequency, type and clinical risk.

RESULTS

Children with MCC averaged 5.3 chronic medications. The reconciliation process took an average of 90 min. Availability/sensitivity/specificity respectively were parents 52%/0.75/0.96, pharmacy 61%/0.64/0.74, primary provider 43%/0.25/0.86, last admission electronic health record 87%/0.74/0.33 and admitting history 65%/0.31/0.94. Thirty-nine errors were identified in 182 admission medications (21%) including 17 omissions, affecting 13 patients (57%). The estimated clinical risk, if an adverse drug event had occurred, was serious or life-threatening in five instances.

CONCLUSIONS

In children with MCC admitted at our institution during the study period, no medication information source was optimally available, sensitive and specific. Admitting order medication errors affected more than half of patients, the most common being omissions. Efforts to improve medication reconciliation at hospital admission in this population must account for availability and accuracy of information sources and medication omissions at the time of hospital admission.

Authors+Show Affiliations

Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA. bryan.stone@hsc.utah.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19948664

Citation

Stone, Bryan L., et al. "Hospital Admission Medication Reconciliation in Medically Complex Children: an Observational Study." Archives of Disease in Childhood, vol. 95, no. 4, 2010, pp. 250-5.
Stone BL, Boehme S, Mundorff MB, et al. Hospital admission medication reconciliation in medically complex children: an observational study. Arch Dis Child. 2010;95(4):250-5.
Stone, B. L., Boehme, S., Mundorff, M. B., Maloney, C. G., & Srivastava, R. (2010). Hospital admission medication reconciliation in medically complex children: an observational study. Archives of Disease in Childhood, 95(4), pp. 250-5. doi:10.1136/adc.2009.167528.
Stone BL, et al. Hospital Admission Medication Reconciliation in Medically Complex Children: an Observational Study. Arch Dis Child. 2010;95(4):250-5. PubMed PMID: 19948664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital admission medication reconciliation in medically complex children: an observational study. AU - Stone,Bryan L, AU - Boehme,Sabrina, AU - Mundorff,Michael B, AU - Maloney,Christopher G, AU - Srivastava,Rajendu, Y1 - 2009/11/30/ PY - 2009/12/2/entrez PY - 2009/12/2/pubmed PY - 2010/5/15/medline SP - 250 EP - 5 JF - Archives of disease in childhood JO - Arch. Dis. Child. VL - 95 IS - 4 N2 - OBJECTIVE: To evaluate admission medication reconciliation in children with medically complex conditions (MCC) by determining the availability and accuracy of five information sources and characterising admitting order errors. DESIGN: Prospective quality improvement cohort study. SETTING: Tertiary care free-standing children's hospital in the Intermountain west, USA. PARTICIPANTS: 23 children with MCC identified from 219 admissions between 16 December 2004 and 7 January 2005. INTERVENTION: Medication reconciliation at hospital admission using information from five sources. MAIN OUTCOMES: The accuracy of information sources was determined by sensitivity and specificity compared with verified outpatient medication lists. Errors were determined by comparing admitting orders with reconciled inpatient medication lists and categorised by frequency, type and clinical risk. RESULTS: Children with MCC averaged 5.3 chronic medications. The reconciliation process took an average of 90 min. Availability/sensitivity/specificity respectively were parents 52%/0.75/0.96, pharmacy 61%/0.64/0.74, primary provider 43%/0.25/0.86, last admission electronic health record 87%/0.74/0.33 and admitting history 65%/0.31/0.94. Thirty-nine errors were identified in 182 admission medications (21%) including 17 omissions, affecting 13 patients (57%). The estimated clinical risk, if an adverse drug event had occurred, was serious or life-threatening in five instances. CONCLUSIONS: In children with MCC admitted at our institution during the study period, no medication information source was optimally available, sensitive and specific. Admitting order medication errors affected more than half of patients, the most common being omissions. Efforts to improve medication reconciliation at hospital admission in this population must account for availability and accuracy of information sources and medication omissions at the time of hospital admission. SN - 1468-2044 UR - https://www.unboundmedicine.com/medline/citation/19948664/Hospital_admission_medication_reconciliation_in_medically_complex_children:_an_observational_study_ L2 - http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=19948664 DB - PRIME DP - Unbound Medicine ER -