Department of Pediatrics, K. Hovnanian Children’s Hospital part of the Meridian Health Sys-tem, 1945 New Jersey 33, Neptune, NJ 07753, USAUnited States
Department of Pharmacy, Jersey Shore University Medical Center part of the Meridian Health System, 1945 New Jersey 33, Neptune, NJ 07753, USA; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ 08854, USAUnited States
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According to The Joint Commission, an accrediting organization certifying healthcare institutions in the United States, medication reconciliation is defined as the comparison between a patient’s medication orders to those the patient was receiving prior to the hospital visit. Its purpose is to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. Medication reconciliation should be completed at every transition of care in which new medications are ordered or existing orders are rewritten when there are changes in setting, service, practitioner, or level of care.1 In a pediatric emergency department setting, medication reconciliation is often challenging, owing to potential medication errors and discrepancies during handoffs at admission, transfer, and discharge of patients.2,3 As a result, an Adverse Drug Event (ADE) defined as any preventable event that results in inappropriate medication use or harm to the patient while the medication is being handled by the health care professional, patient, or consumer can occur. The mean ADE rate in pediatrics is 2.3 to 11.2 per 100 pediatric admissions.1 Therefore, the medication reconciliation process must be observed for safety, quality, and productiveness. This process encompasses five steps: (1) make a list of current home medications; (2) develop a list of medications that will be prescribed; (3) the two lists should then be compared; (4) clinical decisions should be made based on the comparison; and (5) this new list should be conveyed to health professional and patient.4 A recent study conducted in outpatient pediatrics evaluated the implementation of an organized process to improve medication reconciliation. This trial reviewed over 2.7 million visits over a five year period and showed an improvement in documentation of medication reconciliation, satisfying the goal of patient safety.5 The researchers defined patient safety as a means to reduce adverse drug events (ADE) and eliminate preventable harm. This trial used performance of MedRec measured over time from 2005 to 2010 to show that documentation improved consistently from a nadir of 0% in 2005 to 71% in 2010.5 Some research has also been completed on quantifying discrepancies in admission medication history and reconciliation process at a pediatric institution. This prospective study identified a total of 309 discrepancies in 100 charts by pharmacists providing a potential to prevent significant ADEs.6 Similarly, a larger scale review explored the occurrence of medication errors in multiple studies in pediatrics. Many studies consistently identified high rates of discrepancies ranging from 22 to 72.3% that occurred at all transitions of care.7
PEDIATRICS AND NEONATAL NURSING Open Journal http://dx.doi.org/10.17140/PNNOJ-2-e003 ISSN 2377-1569 Pediatr Neonatal Nurs Open J Medication Reconciliation in the Pediatric Emergency Room Praneetha Chaganti1 and Anita Siu2,3* 1Department of Pediatrics, K. Hovnanian Children’s Hospital part of the Meridian Health Sys- tem, 1945 New Jersey 33, Neptune, NJ 07753, USA 2Department of Pharmacy, Jersey Shore University Medical Center part of the Meridian Health System, 1945 New Jersey 33, Neptune, NJ 07753, USA 3Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA *Corresponding author Anita Siu, PharmD Clinical Neonatal/Pediatric Pharmacotherapy Specialist and Clinical Associate Professor Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy at Rutgers University 160 Frelinghuysen Road Piscataway, NJ 08854, USA E-mail: anitasiu@pharmacy.rutgers.edu Article History Received: April 15th, 2015 Accepted: April 15th, 2015 Published: April 17th, 2015 Citation Chaganti P, Siu A. Medication rec- onciliation in the pediatric emer- gency room. Pediatr Neonatal Nurs Open J. 2015; 2(1): e5-e6.
doi: 10.17140/PNNOJ-2-e003 Copyright ©2015 Siu A. This is an open ac- cess article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Volume 2 : Issue 1 Article Ref. #: 1000PNNOJ2e003 Editorial Page e5 According to The Joint Commission, an accrediting organization certifying healthcare institutions in the United States, medication reconciliation is defined as the comparison be- tween a patient’s medication orders to those the patient was receiving prior to the hospital visit. Its purpose is to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. Medication reconciliation should be completed at every transition of care in which new medications are ordered or existing orders are rewritten when there are changes in setting, service, practitioner, or level of care.1 In a pediatric emergency department setting, medication reconciliation is often challenging, owing to potential medication errors and discrepancies dur- ing handoffs at admission, transfer, and discharge of patients. 2,3 As a result, an Adverse Drug Event (ADE) defined as any preventable event that results in inappropriate medication use or harm to the patient while the medication is being handled by the health care professional, patient, or consumer can occur. The mean ADE rate in pediatrics is 2.3 to 11.2 per 100 pediat- ric admissions.1 Therefore, the medication reconciliation process must be observed for safety, quality, and productiveness. This process encompasses five steps: (1) make a list of current home medications; (2) develop a list of medications that will be prescribed; (3) the two lists should then be compared; (4) clinical decisions should be made based on the comparison; and (5) this new list should be conveyed to health professional and patient.4 A recent study conduct- ed in outpatient pediatrics evaluated the implementation of an organized process to improve medication reconciliation. This trial reviewed over 2.7 million visits over a five year period and showed an improvement in documentation of medication reconciliation, satisfying the goal of patient safety.5 The researchers defined patient safety as a means to reduce adverse drug events (ADE) and eliminate preventable harm. This trial used performance of MedRec measured over time from 2005 to 2010 to show that documentation improved consistently from a nadir of 0% in 2005 to 71% in 2010.5 Some research has also been completed on quantifying discrepancies in admission medication history and reconciliation process at a pediatric institution. This pro- spective study identified a total of 309 discrepancies in 100 charts by pharmacists providing a potential to prevent significant ADEs.6 Similarly, a larger scale review explored the occurrence of medication errors in multiple studies in pediatrics. Many studies consistently identified high rates of discrepancies ranging from 22 to 72.3% that occurred at all transitions of care.7 Few studies exist on the medication reconciliation in pediatric emergency depart- ments. Further research is needed to confirm how implementing medication reconciliation may reduce medication errors and improve patient safety in the pediatric emergency department. 8 Guidelines establishing a standardized approach and model for medication reconciliation in the pediatric emergency department are necessary.
PEDIATRICS AND NEONATAL NURSING Open Journal http://dx.doi.org/10.17140/PNNOJ-2-e003 ISSN 2377-1569 Pediatr Neonatal Nurs Open J Page e6 DISCLOSURE There are no conflicts of interest, or financial interest, in any product or service mentioned in the editorial, including grants, employ- ment, gifts, patents, royalties, stocks, and honoraria to report.