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Prevalence and Clinical Significance of Medication Discrepancies at Pediatric Hospital Admission

  • Maitreya Coffey
    Correspondence
    Address correspondence to Maitreya Coffey, MD, FAAP, FRCPC, Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
    Affiliations
    Division of Pediatric Medicine (Dr Coffey and Ms Mack), Department of Critical Care (Ms Streitenberger), Department of Pharmacy (Ms Bishara), and Quality and Risk Management (Dr Matlow), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Ms De Faveri); Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada (Ms Bishara)
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  • Lynn Mack
    Affiliations
    Division of Pediatric Medicine (Dr Coffey and Ms Mack), Department of Critical Care (Ms Streitenberger), Department of Pharmacy (Ms Bishara), and Quality and Risk Management (Dr Matlow), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Ms De Faveri); Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada (Ms Bishara)
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  • Kim Streitenberger
    Affiliations
    Division of Pediatric Medicine (Dr Coffey and Ms Mack), Department of Critical Care (Ms Streitenberger), Department of Pharmacy (Ms Bishara), and Quality and Risk Management (Dr Matlow), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Ms De Faveri); Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada (Ms Bishara)
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  • Teresa Bishara
    Affiliations
    Division of Pediatric Medicine (Dr Coffey and Ms Mack), Department of Critical Care (Ms Streitenberger), Department of Pharmacy (Ms Bishara), and Quality and Risk Management (Dr Matlow), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Ms De Faveri); Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada (Ms Bishara)
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  • Laura De Faveri
    Affiliations
    Division of Pediatric Medicine (Dr Coffey and Ms Mack), Department of Critical Care (Ms Streitenberger), Department of Pharmacy (Ms Bishara), and Quality and Risk Management (Dr Matlow), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Ms De Faveri); Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada (Ms Bishara)
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  • Anne Matlow
    Affiliations
    Division of Pediatric Medicine (Dr Coffey and Ms Mack), Department of Critical Care (Ms Streitenberger), Department of Pharmacy (Ms Bishara), and Quality and Risk Management (Dr Matlow), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada (Ms De Faveri); Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada (Ms Bishara)
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      Objective

      To quantify admission medication discrepancies in a tertiary-care, general pediatric population, to describe their clinical importance and associated factors, and to assess a screening approach to pharmacist involvement.

      Methods

      A total of 272 patients were studied prospectively at hospital admission. The study pharmacist performed a medication history and compared it to physicians' admission medication orders. Discrepancies between the 2 were coded as intentional but undocumented or unintentional. Unintentional discrepancies were rated for potential to cause harm by 3 physicians. Additional data collected included patients' reason for admission and presence of chronic conditions, whether physicians used a medication reconciliation form, the characteristics of patients' home medication regimen, and the time required to perform a pharmacist history and reconciliation. Interrater reliability and associations between baseline characteristics and discrepancy rates were explored.

      Results

      Eighty patients (30%) had at least one undocumented intentional discrepancy (range, 0–7). At least one unintentional discrepancy (range, 0–9) was found in 59 patients (22%). Of the unintentional discrepancies, 23% had moderate and 6% had severe potential to cause discomfort or deterioration. Ratings were similar among the 3 physicians. Characteristics associated with higher risk of clinically important discrepancies were: use of the medication reconciliation form, ≥4 prescription medications, and antiepileptic drug use. Logistic regression revealed that only the variable ≥4 medications was independently associated with clinically important discrepancies.

      Conclusions

      Admission medication errors are common in this tertiary-care, general pediatric population, and nearly a third represent potential adverse events. The use of a medication reconciliation form by physicians without pharmacist involvement does not appear to reduce errors. A cutoff of ≥4 prescription medications is highly sensitive for identifying patients at risk of clinically important discrepancies.

      Key Words

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