BACKGROUND: In December 2007, the National Institute for Health and Clinical Excellence and the National Patient Safety Agency in the UK (NICE-NPSA) published guidance that recommends all adults admitted to hospital receive medication reconciliation, usually by pharmacy staff. A costing and report tool was provided indicating a resource requirement of 12.9 million pounds for England per year. Pediatric patients are excluded from this guidance. OBJECTIVE: To determine the clinical significance of medication reconciliation in children on admission to hospital. METHODS: A prospective observational study included pediatric patients admitted to a neurosurgical ward at Birmingham Children's Hospital, Birmingham, England, between September 2006 and March 2007. Medication reconciliation was conducted by a pharmacist after the admission of each of 100 consecutive eligible patients aged 4 months to 16 years. The clinical significance of prescribing disparities between pre-admission medications and initial admission medication orders was determined by an expert multidisciplinary panel and quantified using an analog scale. The main outcome measure was the clinical significance of unintentional variations between hospital admission medication orders and physician-prescribed pre-admission medication for repeat (continuing) medications. RESULTS: Initial admission medication orders for children differed from prescribed pre-admission medication in 39% of cases. Half of all resulting prescribing variations in this setting had the potential to cause moderate or severe discomfort or clinical deterioration. These results mirror findings for adults. CONCLUSIONS: The introduction of medication reconciliation in children on admission to hospital has the potential to reduce discomfort or clinical deterioration by reducing unintentional changes to repeat prescribed medication. Consequently, there is no justification for the omission of children from the NICE-NPSA guidance concerning medication reconciliation in hospitals, and costing tools should include pediatric patients.
BACKGROUND: In December 2007, the National Institute for Health and Clinical Excellence and the National Patient Safety Agency in the UK (NICE-NPSA) published guidance that recommends all adults admitted to hospital receive medication reconciliation, usually by pharmacy staff. A costing and report tool was provided indicating a resource requirement of 12.9 million pounds for England per year. Pediatric patients are excluded from this guidance. OBJECTIVE: To determine the clinical significance of medication reconciliation in children on admission to hospital. METHODS: A prospective observational study included pediatric patients admitted to a neurosurgical ward at Birmingham Children's Hospital, Birmingham, England, between September 2006 and March 2007. Medication reconciliation was conducted by a pharmacist after the admission of each of 100 consecutive eligible patients aged 4 months to 16 years. The clinical significance of prescribing disparities between pre-admission medications and initial admission medication orders was determined by an expert multidisciplinary panel and quantified using an analog scale. The main outcome measure was the clinical significance of unintentional variations between hospital admission medication orders and physician-prescribed pre-admission medication for repeat (continuing) medications. RESULTS: Initial admission medication orders for children differed from prescribed pre-admission medication in 39% of cases. Half of all resulting prescribing variations in this setting had the potential to cause moderate or severe discomfort or clinical deterioration. These results mirror findings for adults. CONCLUSIONS: The introduction of medication reconciliation in children on admission to hospital has the potential to reduce discomfort or clinical deterioration by reducing unintentional changes to repeat prescribed medication. Consequently, there is no justification for the omission of children from the NICE-NPSA guidance concerning medication reconciliation in hospitals, and costing tools should include pediatric patients.
Authors: Elizabeth B Fortescue; Rainu Kaushal; Christopher P Landrigan; Kathryn J McKenna; Margaret D Clapp; Frank Federico; Donald A Goldmann; David W Bates Journal: Pediatrics Date: 2003-04 Impact factor: 7.124
Authors: Sabrina De Winter; Isabel Spriet; Christophe Indevuyst; Peter Vanbrabant; Didier Desruelles; Marc Sabbe; Jean Bernard Gillet; Alexander Wilmer; Ludo Willems Journal: Qual Saf Health Care Date: 2010-07-01
Authors: Navneet Sanghera; Po-Yi Chan; Zahra F Khaki; Claire Planner; Kenneth K C Lee; Noël E Cranswick; Ian C K Wong Journal: Drug Saf Date: 2006 Impact factor: 5.606
Authors: Patricia L Cornish; Sandra R Knowles; Romina Marchesano; Vincent Tam; Steven Shadowitz; David N Juurlink; Edward E Etchells Journal: Arch Intern Med Date: 2005-02-28
Authors: Bryan L Stone; Sabrina Boehme; Michael B Mundorff; Christopher G Maloney; Rajendu Srivastava Journal: Arch Dis Child Date: 2009-11-30 Impact factor: 3.791
Authors: Chi Huynh; Ian C K Wong; Stephen Tomlin; David Terry; Anthony Sinclair; Keith Wilson; Yogini Jani Journal: Paediatr Drugs Date: 2013-06 Impact factor: 3.022
Authors: Daniel B Hawcutt; Naomi Warner; Elaine Kenyon; Christine Murray; Julia Taylor; James Moss; Stephen McWilliam; Will Weston; Nicki Murdock Journal: Br J Clin Pharmacol Date: 2021-08-22 Impact factor: 3.716