Medication Discrepancy Risk Factors for Pediatric Patients With Epilepsy at Hospital Admission

Abstract

BACKGROUND Children with epilepsy are at increased risk of medication errors due to disease complexity and administration of time-sensitive medication. Errors frequently occur during transitions of care between home and hospital, a time when accuracy of medication history lists is difficult to ascertain. Adverse events likely from medication discrepancies underscore the importance of improving medication reconciliation upon inpatient intake. This quality improvement project was designed to evaluate and optimize the current medication history process in epileptic patients upon hospital admission at a pediatric academic hospital. METHODS A retrospective chart review was conducted on 30 patients with epilepsy admitted in during April, July, and October 2018 to identify unintentional medication discrepancies among 6 sources: documented medication history, inpatient orders from the electronic medical record, outpatient clinic notes, inpatient history and admission document, phone message records, and external insurance claims. RESULTS A total of 63% percent of patients had at least 1 unintentional medication discrepancy. Most discrepancies occurred with daily maintenance anticonvulsants (63%). The most common types were omission of medication history (31%) and inpatient order omissions (27%). The number of medication histories completed with at least 1 discrepancy varied across pharmacists, nurses, and physicians, yet differences were not statistically significant. CONCLUSIONS Our study found a higher incidence of anticonvulsant discrepancies compared with previous studies. This quality improvement initiative identified the absence of a standardized process as the root cause for the high incidence of anticonvulsant discrepancies in pediatric patients with epilepsy at hospital admission.

Effect of frailty on medication deviation during the hospital-family transition period in older patients with cardiovascular disease: An observational study

“…[5][6][7] MD not only increases the readmission rate of patients, resulting in poor prognosis, but is also the main cause of adverse drug events. [8,9] The hospital-home transition period is a crucial period of transitional care for patients and includes up to 2 months before discharge to home. [10,11] Ideally, the transition period should include a comprehensive transitional care plan; however, real-life evidence suggests that during the transition period, there is often a lack of continuity of related medication caused by reasons such as delayed information communication.…”