Hospital admission medication reconciliation in medically complex children: an observational study
- Bryan L Stone1,2,
- Sabrina Boehme1,
- Michael B Mundorff1,
- Christopher G Maloney1,2,
- Rajendu Srivastava1,2,3
- 1Primary Children's Medical Center, Intermountain Healthcare, Salt Lake City, Utah, USA
- 2Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
- 3Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah, USA
- Correspondence to Dr Bryan L Stone, 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{at}hsc.utah.edu
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Contributors BS had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors are responsible for the study conception and design (BS, RS, SB), acquisition of data (BS, SB), analysis and interpretation of data (BS, RS, MM, SB, CM), drafting of the manuscript (BS, RS, SB, MM), critical revision of the manuscript (BS, RS, SB, MM, CM), statistical analysis (BS, RS, MM), technical support (MM) and supervision (RS, CM).
- Accepted 6 November 2009
- Published Online First 30 November 2009
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.
Footnotes
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Funding RS is the recipient of a Eunice Kennedy Shriver National Institute of Child Health and Human Development career development award K23 HD052553, and this project was supported in part by the Children's Health Research Center at the University of Utah and Primary Children's Medical Center Foundation.
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Competing interests None.
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Ethics approval Ethics approval was provided by the University of Utah; Intermountain Healthcare.
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Provenance and peer review Not commissioned; externally peer reviewed. Patient consent Not obtained.
