A pharmacist-led medication reconciliation and review program in a pediatric ward
DOI:
https://doi.org/10.30968/jhphs.2025.164.1313Abstract
Objective: To determine the types of drug discrepancies at different points in the transition of care (admission, transfer, and discharge) and medication errors in hospitalized pediatric patients. Methods: This observational study was conducted from April to August 2019 with pediatric patients admitted to a university hospital in Minas Gerais, Brazil. The patients included were aged between 28 days and 12 years, and their guardians were interviewed within the first 48 hours after admission. Based on medication reconciliation, intentional and unintentional discrepancies were assessed at all transitions of care, and medication review was performed according to the Pharmaceutical Care Network Europe guidelines for identifying medication errors. Data were analyzed using the SPSS software. A descriptive analysis of the outcomes and other variables was performed, presenting the frequency and percentage of qualitative variables, as well as the median of quantitative variables of quantitative variables. Pearson’s chi-square test was performed for association of variables, with a 95% significance level. Results: Sixty-nine patients were included. The majority were male (55.1%; n = 38), with a median age (SD) of 34.09 (3.4) years (variation of 0 to 12). A total of 399 drug discrepancies were identified, with the transfer from the emergency room to hospital care being the interface with the highest rate of undocumented intentional discrepancies (10.0%; p = 0.001). Unintentional discrepancies were more frequent during the transition from home to the emergency room (13.3%; p = 0.001). Regarding medication review, 185 medication errors were identified in 79.7% of patients, 65.3% of which were related to treatment safety. Regarding transitions of care and hospitalization, 40.6% of patients presented unintentional drug discrepancies and medication errors. Conclusion: Integrated medication review with medication reconciliation can be effective in reducing harm, promoting treatment safety, and optimizing patient’s pharmacoterapy.
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