Prevalence of medication discrepancies in pediatric patients transferred between hospital wards

• Published in: International journal of clinical pharmacy Vol. 43; no. 4; pp. 909 - 917
• Main Authors: Alcântara, Thaciana dos Santos, de Araújo Neto, Fernando Castro, Lima, Helena Ferreira, de Araújo, Dyego Carlos S. Anacleto, Sanchez, Júlia Mirão, Aires-Moreno, Giulyane Targino, Silvestre, Carina de Carvalho, de Lyra Junior, Divaldo P.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2021; Springer Nature B.V
• Subjects: Data collection; Internal Medicine; Medical errors; Medical records; Medicine; Medicine & Public Health; Patients; Pediatrics; Pharmacy; Research Article; Patient transfer; Medication discrepancies; Hospitals; Children; Medication errors
• ISSN: 2210-7703; 2210-7711
• DOI: 10.1007/s11096-020-01196-w

Background Children are more susceptible to harm from medication errors and adverse drug reactions when compared to adults. Such events may occur from medication discrepancies while transitioning patients throughout the healthcare system. Contributing factors include medication discontinuity and lack of information by the healthcare team. Objective To analyze the prevalence of medication discrepancies in transition points of care in a pediatric department. Setting  Pediatric department of a public hospital in Northeast Brazil. Method  A cross-sectional study was carried out from August 2017 to March 2018. Data collection consisted of the following steps: collection of sociodemographic data, clinical interview with the patient’s caregiver, registration of patient prescriptions, and evaluation of medical records. Medication discrepancies were classified as intentional and unintentional. The unintentional medication discrepancies were classified as omission of medication, therapeutic duplicity, and differences in dose, frequency, or route of administration. Main outcomes measure  Discrepancy profile identified at admission, internal transfer and hospital discharge. Results Among the 114 patients included in the study, 85 (74.5%) patients had at least one unintentional medication discrepancy, of which 16 (14.0%) patients presented medication discrepancies at hospital admission, 42 (36.8%) patients at internal transfer, and 52 (45.6%) patients during discharge. Omission of medication represented 20 (74.1%) errors at admission, 26 (37.7%) errors at internal transfer, and 80 (100.0%) errors at hospital discharge. Conclusions The main transition points of care where unintentional discrepancies occurred in the studied pediatric department were at internal transfer and hospital discharge, with omission being the most common type of unintentional discrepancy.