Related Experiment Video
Updated: Jun 29, 2025
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit
Sara Adducchio1, Ethan D Grant1, Laura D Fonseca1
1Department of Neurology (SA, LDF, GK), Dayton Children's Hospital; Department of Pediatrics (EDG, GK), Wright State University Boonshoft School of Medicine, Dayton; and Department of Nephrology (AO), Dayton Children's Hospital, OH.
Insights
Reducing discharge medication reconciliation errors in pediatric epilepsy patients is achievable. Specialty neurology nurses and standardized electronic orders significantly decreased errors, improving patient safety without added hospital costs.
Area of Science:
- Pediatric Neurology
- Health Quality Improvement
- Medication Safety
Background:
- Discharge medication reconciliation (DMR) errors are prevalent in pediatrics, with rates from 26% to 42.2%.
- These errors pose significant risks, especially during care transitions for pediatric patients.
- A quality improvement project was initiated to address high DMR error rates at Dayton Children's Hospital.
Purpose of the Study:
- To decrease the discharge medication reconciliation error rate in pediatric patients.
- To implement and evaluate targeted interventions for improving medication accuracy upon discharge.
- To specifically reduce errors related to seizure rescue medications in epilepsy patients.
Main Methods:
- Two interventions were implemented using Plan-Do-Study-Act cycles over 19 months (September 2021 - February 2023).
- Intervention 1: Employed specialty neurology nurses as scribes with a standardized discharge care plan template.
- Intervention 2: Standardized seizure rescue medication orders via an electronic medical record order panel.
Main Results:
- The baseline DMR error rate was 15.7% (7 errors/month).
- Following Intervention 1, the error rate decreased to 5.3% (2 errors/month).
- After Intervention 2, the rate further dropped to 2.9% (1 error/month), with a subsequent 10-week period of 0% errors.
Conclusions:
- Sustainable reduction in pediatric DMR errors, particularly for epilepsy patients, was achieved.
- Utilizing specialty neurology nurses and electronic order panels effectively improved discharge medication accuracy.
- These interventions enhanced patient safety without incurring additional hospital costs.
Background And Objectives:
Medication reconciliation errors are a common problem in health care, particularly during transitions of care. Discharge medication reconciliation (DMR) errors in a pediatric setting can range from 26% to 42.2%. We conducted a quality improvement project to decrease DMR error rate at Dayton Children's Hospital in Dayton, Ohio.
Methods:
We conducted 2 interventions, each with 3 Plan-Do-Study-Act cycles from September 2021 through February 2023. The first intervention focused on using current specialty neurology nurses as scribes and creating a template note to include the plan of care and review of DMR before discharge. Our second intervention consisted of standardizing the seizure rescue medication order by creating an order panel within our electronic medical record system for all the rescue medications presently available. Medication errors were documented by the specialty neurology nurse during a phone conversation on the next business day post discharge. DMR error rates were calculated for each week using a control chart. Medication errors and patient harm were classified according to the National Coordinating Council for Medication Error Reporting and Prevention Index.
Results:
One hundred six errors were noted. Of these, 98 (92%) occurred in patients with seizure and 64 (60%) were related to prescription of seizure rescue medication specifically. The baseline error rate was calculated at 15.7% or 7 errors per month (January 2021 through June 2021). The average error rate dropped from 15.7% to 5.3% (2 errors per month) after initiation of our first intervention (September 2021). Twelve weeks after initiation of the second intervention, a 2.9% (1 error per month) was noted. Afterward, there was a ten-week period of 0% errors.
Discussion:
Sustainable reduction of DMR errors in pediatric patients with epilepsy was achieved by using specialty neurology nurses to scribe the care plan and creating order panels to facilitate accuracy of discharge medication orders without additional cost to the hospital.
Related Concept Videos
01:18Guidelines and Strategies for Safe Computer Charting
Maintain Confidentiality and Security:
01:30Guidelines for Nursing Documentation I
Factual:
The following points emphasize the significance of upholding accurate and unbiased documentation in healthcare.
01:21Factors Affecting Drug Response: Overview
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:28Drug Therapy
Antianxiety Medications
01:06Legal Guidelines for Documentation