Medication errors make up a staggering portion of medical error in the United States. These medication errors are most likely to occur at transitions in care. Children with medical complexity (CMC) often rely on multiple medications to maintain their health, making accurate medication ordering of utmost importance to avoid exacerbating chronic conditions or unnecessary harm. Because of their increased medication usage, CMC have an increased risk of medication ordering error (MOE). To better inform the medication reconciliation process for CMC, we examine the prevalence, category, and risk factors of MOE at hospital admissions for this patient population.
A retrospective cohort analysis of 1,237 hospitalized CMC from two tertiary pediatric teaching hospitals with clinical care services for CMC was performed on data from November 1, 2015 to October 31, 2016. Pharmacists and advance nurse practitioners identified MOEs at admissions through medical record review, patient history at interview, and inpatient team discussions. Identified MOEs were classified as one of seventeen different categories, some of which include duplications, omissions, or incorrect frequency, dose, or route. Statistical analysis was performed using Fisher’s exact test, chi-squares, and generalized linear mix models to examine the relationships between MOEs at admission and patient characteristics, such as ethnicity, number of chronic conditions, or number of medications taken at admission.
A total of 115 admission MOEs were identified in 73 hospitalized CMC. The two most common MOE types were wrong dose (41.7%) and omitted medication (33.9%). The median number of medications ordered at admission was 10 (IQR 6-14). Medications most commonly associated with an MOE were cholecalciferol (n=9) and baclofen (n=9). As for patient characteristics, the median age at admission was 5 years ([Interquartile Range [IQR] 1-12). Of the total sample, 96.8% had a complex chronic condition and 72.8% were technology dependent. Children who are Black, require medical technology, or take more than 15 medications during hospitalization were found to have higher MOE rates. Multivariable analysis revealed the highest odds of MOE in children taking baclofen (Odds Ratio [OR] 2.6 [95% Confidence Interval {CI} 1.4-4.7]).
MOEs at admission are prevalent among hospitalized CMC. Further study on medication safety in CMC is needed to inform medication reconciliation processes and better prevent patient harm. / 2019-07-03T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/30814 |
| Date | 03 July 2018 |
| Creators | Akula, Vinita |
| Contributors | Garcia-Diaz, J. Fernando, Berry, Jay G. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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