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Clinical Significance of Medication Reconciliation in Children Admitted to a UK Pediatric Hospital

Observational Study of Neurosurgical Patients

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Abstract

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 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.

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Acknowledgements

We thank Carole Cummins and Claire Norton for their assistance with the design of this study and Maya Patel for her technical assistance in undertaking medication reconciliation. No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study. An application has been made to the Neonatal and Paediatrics Pharmacists’ Group (UK) to support an extension of this study at additional sites.

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Authors and Affiliations

  1. Department of Pharmacy, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, England

    David R. P. Terry & Anthony G. Sinclair

  2. Department of Neurosurgery, Birmingham Children’s Hospital, Birmingham, England

    Guirish A. Solanki

  3. School of Pharmacy, Aston University, Aston Triangle, Birmingham, England

    John F. Marriott & Keith A. Wilson

Authors
  1. David R. P. Terry
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  2. Guirish A. Solanki
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  3. Anthony G. Sinclair
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  4. John F. Marriott
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  5. Keith A. Wilson
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Corresponding author

Correspondence to David R. P. Terry.

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Terry, D.R.P., Solanki, G.A., Sinclair, A.G. et al. Clinical Significance of Medication Reconciliation in Children Admitted to a UK Pediatric Hospital. Pediatr-Drugs 12, 331–337 (2010). https://doi.org/10.2165/11316230-000000000-00000

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