Chi Huynh1,2, Ian Chi Kei Wong1,3, Stephen Tomlin4, Ellisha Halford1,4, Yogini Jani1,5, Maisoon Ghaleb6. 1. Department of Practice and Policy, Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK. 2. Academic Practice Unit, Pharmacy Department, Birmingham Children's Hospital, Birmingham, UK. 3. Department of Pharmacology & Pharmacy, Centre for Safe Medication Practice and Research, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China. 4. Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, UK. 5. Department of Practice and Policy, University College London Hospitals NHS Foundation Trust, London, UK. 6. Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Welwyn Garden City, UK.
Abstract
OBJECTIVE: A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting. METHODS: Five weeks prospective review of hospital discharge letters was carried out. Medication discrepancies between the initial doctor's discharge letter and finalised drug chart were identified, pharmacist changes were recorded and their severity was assessed. The setting of the review was at a London, UK paediatric hospital providing local secondary and specialist tertiary care. The outcome measures were: - incidence and the potential clinical severity of medication discrepancies identified by the hospital pharmacist at discharge. KEY FINDINGS: 142 patients (64 female and 78 males, age range 1 month - 18 years) were discharged on 501 medications. The majority of patients were under the care of general surgery and general paediatric teams. One in three discharge letters contained at least one medication discrepancy and required pharmacist interventions to rectify prior to completion. Of these, 1 in 10 had the potential for patient harm if undetected. CONCLUSIONS: Medicines reconciliation by pharmacist at discharge may be a good intervention in preventing medication discrepancies which have the potential to cause moderate harm in paediatric patients.
OBJECTIVE: A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting. METHODS: Five weeks prospective review of hospital discharge letters was carried out. Medication discrepancies between the initial doctor's discharge letter and finalised drug chart were identified, pharmacist changes were recorded and their severity was assessed. The setting of the review was at a London, UK paediatric hospital providing local secondary and specialist tertiary care. The outcome measures were: - incidence and the potential clinical severity of medication discrepancies identified by the hospital pharmacist at discharge. KEY FINDINGS: 142 patients (64 female and 78 males, age range 1 month - 18 years) were discharged on 501 medications. The majority of patients were under the care of general surgery and general paediatric teams. One in three discharge letters contained at least one medication discrepancy and required pharmacist interventions to rectify prior to completion. Of these, 1 in 10 had the potential for patient harm if undetected. CONCLUSIONS: Medicines reconciliation by pharmacist at discharge may be a good intervention in preventing medication discrepancies which have the potential to cause moderate harm in paediatric patients.
Authors: Thaciana Dos Santos Alcântara; Fernando Castro de Araújo Neto; Helena Ferreira Lima; Dyego Carlos S Anacleto de Araújo; Júlia Mirão Sanchez; Giulyane Targino Aires-Moreno; Carina de Carvalho Silvestre; Divaldo P de Lyra Junior Journal: Int J Clin Pharm Date: 2020-11-11
Authors: Thao T Nguyen; Erica Bergeron; Teresa V Lewis; Jamie L Miller; Tracy M Hagemann; Stephen Neely; Peter N Johnson Journal: SAGE Open Med Date: 2020-06-03