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MEDICINES RECONCILIATION FOR PAEDIATRIC PATIENTS ON ADMISSION AND DISCHARGE
Maria Moss1, Celine Bilbul1, Jo Crook1
1Chelsea and Westminster NHS Foundation Trust.
Insights
Medicines reconciliation (MR) for paediatric patients fell short of national standards, highlighting a need for improved processes. Timely documentation and pharmacist involvement are crucial for reducing medication errors in children.
Area of Science:
- Paediatric Pharmacy Practice
- Medication Safety
- Healthcare Quality Improvement
Background:
- National guidance emphasizes accurate medicines reconciliation (MR) to reduce medication errors during care transitions.
- Current MR guidelines exclude children under 16, a group at higher risk due to off-label and unlicensed formulations.
- Paediatric patients require specific attention to ensure safe medication management.
Purpose of the Study:
- To quantitatively assess the level of medicines reconciliation for paediatric inpatients.
- To evaluate the timeliness of medication history documentation and reconciliation on admission and discharge.
- To determine if discharge summaries are sent to General Practitioners (GPs) promptly.
Main Methods:
- Retrospective audit of paediatric take-home prescriptions over two weeks.
- Utilized an electronic prescribing system for data collection on MR processes.
- Employed Qualtrics software for data entry and Microsoft Excel for analysis.
Main Results:
- Only 49.2% of patients had drug history documented within 24 hours of admission.
- 60.0% of patients had medicines reconciled by a pharmacist within 72 hours of admission.
- 70.8% had medicines reconciled at discharge, and 87.7% had discharge summaries sent to GPs within 24 hours.
Conclusions:
- None of the four audited standards for paediatric medicines reconciliation were met.
- Identified a need for more medicines reconciliation technicians and improved out-of-hours support.
- Emphasized the necessity of multidisciplinary team collaboration and enhanced pharmacist understanding of MR processes.
Introduction:
National guidance from National Institute for Health and Clinical Excellence (NICE), National Patient Safety Agency (NPSA), World Health Organization and the Royal Pharmaceutical Society has long highlighted the importance of accurate and timely medicines reconciliation (MR) in reducing medication errors for patients upon transfer of care setting.1 (-) 4 Current guidance for MR excludes children <16 years of age, where widespread use of off-label and unlicensed formulations puts this group of patients at a higher risk.
Aim:
To quantitatively assess the level of MR for paediatric inpatients on admission and discharge and to ascertain whether Discharge Summary (DSUM) information is sent to the GP in a timely manner.
Method:
▸ Data was collected retrospectively over a two week period for paediatric take home prescriptions.▸ An electronic prescribing system was used to complete a data collection form, documenting their MR process and timeframe on admission and discharge.▸ The information was recorded onto an online template of the data collection form using Qualtrics software to prepare a Microsoft Excel file for data analysis.
Results:
65 paediatric patients on four wards were audited.▸ Standard 1: 32/65 (49.2%) of patients had their drug history (DH) documented within 24 hrs of admission.▸ Standard 2: 39/65 (60.0%) of patients had their medicines reconciled by a pharmacist within 72 hrs of admission.▸ Standard 3: 46/65 (70.8%) of patients had their medicines reconciled by a pharmacist and/or doctor at discharge.▸ Standard 4: 57/65 (87.7%) of patients had their DSUM sent to the GP within 24 hrs of discharge.
Conclusion:
None of the four standards were met, emphasising the need to develop better MR practice. The following conclusions were identified:▸ A need for more MMTs at ward level to conduct accurate DHs within a timely manner.▸ MR on admission and discharge suffers out-of-hours (OOH), thus supporting plans for seven-day working.▸ A combined effort between different members of the multidisciplinary team is paramount to ensure accurate MR.▸ Doctors need to have the resources available OOH to allow them to prioritise completion of DSUMs in a timely manner to optimise accurate MR communication with GPs.▸ It is evident that anecdotally MR is done to a higher level; however a possible lack of pharmacist understanding on the MR process and its documentation may have contributed to this audit's standards not being met.
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