Admission medication reconciliation service for paediatric and adolescent ward at Princess Margaret Hospital (PMH)

Abstract Description

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Authors (including presenting author) :

Wong BTH(1), Ng V(1), Chiu CCH(1)

Affiliation :

Pharmacy Department, Princess Margaret Hospital

Introduction :

Medication reconciliation (MR) is an effective process to identify any unintended medication discrepancies for patients who are experiencing transition of care.

Objectives :

The aim of the pharmacist-led medication reconciliation service is to reduce and avoid potential medication errors, drug-related problems (DRP) and improve medication safety.

Methodology :

Medication reconciliation is conducted for patients admitted to the specific pediatric and adolescent ward, Medication is reconciled by pharmacist, with priority for patients admitted within 24 hours. Information of patient’s medication history is collected via different sources. Reconciled medication list is compared to the prescribed medication list to identify any unintended medication discrepancies. Pharmacist would investigate and provide interventions on any medication discrepancies with reference to patient’s clinical information and consult practitioner to resolve the discrepancies. Pharmacist is also responsible to conduct compliance checks for patients with long term medications and ascertain any differences to their drug regimen compared with their previous follow up. All unintended medication discrepancies and interventions are documented. The clinical significance of the interventions was ranked using the Hatoum’s scale by two independent pharmacists.

Result & Outcome :

For the period of 1st August 2017 to 31st July 2018, admission medication reconciliation was conducted for 1883 admission episodes. 1495 (79 percent) patients received the service within 24 hours of admission, 275 (15 percent) patients conducted between 24 to 48 hours post admission and 113 (6 percent) patients conducted 48 hours or more post admission. 301 (16 percent) patients had at least one chronic medication prior to admission, whilst the remaining patients were either not on medication or only had short term symptomatic medications prior admission. Approximately 7 percent of patients with chronic medication were involved with unintended discrepancies resulting to 27 drug-related problems. The discrepancies included omission of medication (78 percent), no clear indication for drug use (11 percent) and wrong dosage (11 percent). Interventions involved resumption of medication, discontinuing inappropriate medication and medication dosage change. Of all the interventions, 22 percent were ranked to be “somewhat significant”, 61 percent were ranked to be “significant” and 17 percent were ranked to be “very significant” according to the Hatoum’s scale. All suggestions made by pharmacists were accepted by doctors and problems were resolved. Early admission medication reconciliation was provided to the majority of patients. Omission of medication was the most common unintended discrepancy on admission. Clinical pharmacist has a role in identifying these DRP and can intervene on admission to improve the medication safety. Patients with poor drug compliance were identified and counseling given accordingly.