Huynh, Chi; (2013) Medicines Reconciliation Research in Young Patients (MERRY). A series of exploratory studies and service evaluations on the clinical significance of medicines reconciliation in children upon transitions in care between home and hospital. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Medication discrepancies occurring at the interfaces of care between hospital and home may cause patient harm. Medication reconciliation (also known as medicines reconciliation) has been suggested as an intervention that may reduce discrepancies. National guidance has made it mandatory for hospitals in the UK to have Medication Reconciliation policies in place for adult patients admitted to hospital. This policy excluded children aged less than 16 years. This thesis aimed to investigate the incidence and potential clinical outcome of medication discrepancies occurring across the interface of care for hospitalized children from admission, discharge and post-discharge. At hospital admission across four UK paediatric settings it was observed that 32% (95% CI = 26.1 – 37.8%) of 244 paediatric patients had at least one potentially clinically significant unintended discrepancy between their pre-admission medication and initial admission medication order in the absence of pharmacist-led medication reconciliation. At discharge, approximately one third of 142 discharge letters reviewed for accuracy over 5 weeks had at least one discrepancy which were detected and corrected by a pharmacist. Post-discharge follow up of patients revealed that 7.7% (95% CI 1.1 – 16%) of patients experienced at least one discrepancy between what was prescribed by the hospital at discharge in comparison to what was prescribed by the GP. Qualitative observations revealed that more than one source of information were required to reconcile medication at admission and GP records did not provide a complete medication history. Post discharge observations highlighted that hospital discharge letters were not always clear resulting in discrepancies between the intended discharge medication list and GP record. This work provides evidence that children aged less than 18 years of age require medication reconciliation when transferring between primary and secondary care. Preventable interventions are required across the care settings to ensure patient safety and to reduce chances of preventable adverse events.

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