title: An evaluation of paediatric medicines reconciliation at hospital discharge into the community.
abstract: OBJECTIVE
  A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting.
  
  
  METHODS
  Five weeks prospective review of hospital discharge letters was carried out. Medication discrepancies between the initial doctor's discharge letter and finalised drug chart were identified, pharmacist changes were recorded and their severity was assessed. The setting of the review was at a London, UK paediatric hospital providing local secondary and specialist tertiary care. The outcome measures were: - incidence and the potential clinical severity of medication discrepancies identified by the hospital pharmacist at discharge.
  
  
  RESULTS
  142 patients (64 female and 78 males, age range 1 month - 18 years) were discharged on 501 medications. The majority of patients were under the care of general surgery and general paediatric teams. One in three discharge letters contained at least one medication discrepancy and required pharmacist interventions to rectify prior to completion. Of these, 1 in 10 had the potential for patient harm if undetected.
  
  
  CONCLUSIONS
  Medicines reconciliation by pharmacist at discharge may be a good intervention in preventing medication discrepancies which have the potential to cause moderate harm in paediatric patients.
authors.affiliation: Department of Practice and Policy, Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK.|Academic Practice Unit, Pharmacy Department, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Chi
authors.initials: C
authors.lastname: Huynh
authors.affiliation: Department of Practice and Policy, Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK.|Department of Pharmacology & Pharmacy, Centre for Safe Medication Practice and Research, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: Ian Chi Kei
authors.initials: IC
authors.lastname: Wong
authors.affiliation: Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tomlin
authors.affiliation: Department of Practice and Policy, Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK.|Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, King's Health Partners, London, UK.
authors.forename: Ellisha
authors.initials: E
authors.lastname: Halford
authors.affiliation: Department of Practice and Policy, Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK.|Department of Practice and Policy, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Yogini
authors.initials: Y
authors.lastname: Jani
authors.affiliation: Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Welwyn Garden City, UK.
authors.forename: Maisoon
authors.initials: M
authors.lastname: Ghaleb
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D059065:Medication Reconciliation / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D011446:Prospective Studies
keywords: discharge; interface issues; medication risk; medicines reconciliation; patient safety