title: An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital.
abstract: OBJECTIVE
  To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm.
  
  
  METHODS
  A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses.
  
  
  RESULTS
  Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases.
  
  
  CONCLUSIONS
  This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.
authors.affiliation: Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK Academic Practice Unit, Pharmacy, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Chi
authors.initials: C
authors.lastname: Huynh
authors.affiliation: Department of Pharmacy, Evelina Children's Hospital, King's Health Partners, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tomlin
authors.affiliation: Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK Department of Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Yogini
authors.initials: Y
authors.lastname: Jani
authors.affiliation: Neurosurgery Department, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Guirish A
authors.initials: GA
authors.lastname: Solanki
authors.affiliation: Department of Pharmacy, University Hospitals of North Midlands NHS Trust, Staffordshire, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Haley
authors.affiliation: Department of Pharmacy, Leeds Children's Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Smith
authors.affiliation: Department of Pharmacy, Leeds Children's Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lowey
authors.affiliation: Academic Practice Unit, Pharmacy, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sinclair
authors.affiliation: School of Pharmacy, Aston University, Birmingham, UK.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Wilson
authors.affiliation: Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, China.
authors.forename: Ian Chi Kei
authors.initials: IC
authors.lastname: Wong
authors.affiliation: Academic Practice Unit, Pharmacy, Birmingham Children's Hospital, Birmingham, UK School of Pharmacy, Aston University, Birmingham, UK.
authors.forename: David
authors.initials: D
authors.lastname: Terry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008487:Medical History Taking / Q000592:standards; D008508:Medication Errors / Q000706:statistics & numerical data*; D059065:Medication Reconciliation / Q000592:standards / Q000706:statistics & numerical data; D008511:Medicine / Q000706:statistics & numerical data; D010343:Patient Admission / Q000592:standards; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies
keywords: Epidemiology; Health services research