Aim Medicines-related patient safety incidents are more likely to occur when medicines reconciliation happens over 24 hours of admission to an acute setting.¹ At our trust, the pharmacy team provide a weekend medicines reconciliation service, but this excludes paediatric patients. The aim of this audit was to determine the number of paediatric patients admitted outside of pharmacy working hours (from Friday evening to Sunday evening) over a 17 week period to identify the need to include paediatric patients in the weekend medicines reconciliation service.

Method Data was collected from a 24 bed in-patient paediatric ward. The number of paediatric patients admitted outside of normal working hours were recorded every Monday using the daily ward handover and the results collated on an excel spreadsheet.

Results From the 310 patients audited, 58% of patients (n=180) were admitted outside of normal pharmacy working hours, and hence did not have their medicines reconciliation completed. Furthermore, at least 30% of patients were new to the ward every Monday. Excluding the 4 bank holiday weeks, there was a mean percentage of 55% new patients across 13 weeks.

Conclusion The results of this audit suggest there is a clear necessity and benefit for weekend medicines reconciliation to include paediatric patients.

It is known that drug histories completed by the pharmacy team can lead to a shorter length of stay and a lower in-hospital mortality rate in adult patients² and that pharmacist acquired medication histories are more complete than those acquired by other health professionals as evidence shows that 33% of medicine discrepancies between the actual admissions medications orders compared to the pharmacist’s expected admission medications order.^{3 4}

Including paediatric patients could reduce potential clinical harm as a result of discrepancies that can occur across the interfaces of care as evidence has shown 78% of the medication history held by the GP prior to admission versus admission medications order discrepancies have the potential to cause moderate to serious harm if left unresolved.⁴ Although the complexity of the medicines reconciliations in this audit were not considered there are several factors to consider when evaluating the risks of omitting paediatric patients from the weekend service. Doctors are often not aware of multiple concentrations of oral liquids being available leading to dosing errors where doses are prescribed in millilitres rather than in units (e.g. milligrams or micrograms). Moreover, there are sometimes discrepancies between the sources used for medicines reconciliation.

References

1. NICE Medicines optimisation Quality standard [QS120]. Published: 24 March 2016.

2. Marshall J, Hayes BD, KoehL J, et al. Effects of a pharmacy-driven medication history program on patient outcomes. American Journal of Health-System Pharmacy 2022;79:1652–1662, https://doi.org/10.1093/ajhp/zxac143

3. Carter MK, Allin DM, Scott LA, et al. Pharmacist-acquired medication histories in a university hospital emergency department. American Journal of Health-System Pharmacy 2006;63:2500–2503, https://doi.org/10.2146/ajhp060028

4. Jani Y, Terry D, Wong I, Huynh C, Tomlin S, Lowey A, et al. The clinical significance of medicines reconciliation (MR) in children admitted to hospital: development and evaluation of pharmacy led admission services [Internet]. Neonatal Paediatric Pharmacists Group; 2013 https://qicentral.rcpch.ac.uk/medsiq/medicines-safety/medicines-reconciliation-in-children/ (Accessed 17 May 2023).