Development of a Discharge Counseling and Medication Reconciliation Process for Pediatric Patients Within a Large,...

Area of Science:

• Pediatric Pharmacy Practice
• Health Services Research
• Quality Improvement

Background:

• Transitions of care for high-risk pediatric patients present significant challenges.
• Medication errors and gaps in care are common during hospital discharge.
• Effective interventions are needed to improve patient safety and outcomes.

Purpose of the Study:

• To evaluate the impact of a pharmacist-driven program for discharge medication reconciliation and counseling.
• To target high-risk pediatric patients to reduce barriers in care transitions.
• To characterize the interventions performed by pharmacists.

Main Methods:

• A single-center quality improvement initiative was conducted.
• A scoring system identified high-risk pediatric patients for readmission.
• A trigger tool was integrated into the electronic medical record (EMR).

Main Results:

• Pediatric pharmacists completed 60 medication reconciliations and 5 counseling sessions for 60 patients in 2 months.
• A total of 65 interventions were performed, focusing on dosing, duration, and medication additions.
• All pharmacist recommendations were accepted and implemented by providers.

Conclusions:

• Pharmacist-led discharge medication reconciliation and counseling programs can effectively mitigate care transition gaps.
• Targeting high-risk pediatric populations enhances the program's impact.
• This initiative demonstrates a valuable role for pharmacists in pediatric care transitions.