Hospital Admission Medication Reconciliation in Medically Complex Children, an Observational Study

Abstract

Objective: To evaluate admission medication reconciliation in children with medically complex conditions (MCC) by determining availability and accuracy of 5 information sources and characterizing 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 12/16/04 and 1/7/05.

Intervention: Medication reconciliation at hospital admission using information from 5 sources.

Main outcomes: Accuracy of information sources determined by sensitivity and specificity compared to verified outpatient medication lists. Errors were determined by comparing admitting orders to reconciled inpatient medication lists, and categorized by frequency, type, and clinical risk.

Results: Children with MCC averaged 5.3 chronic medications. The reconciliation process took an average of 90 minutes. 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. 39 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 5 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.