Medication Reconciliation in the Pediatric Emergency Room

Abstract

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