O4 Determining the accuracy of GP records in paediatric medicines reconciliation
Authors: Cuevas Octavio Aragon , Jones Levi Stenson 
Published: June 2019

Aim

Medicines reconciliation (MedRec) is a process undertaken on admission to hospital to obtain an accurate list of patients’ current medication.1 National guidance for MedRec is available only in adults. Previous studies looking at accuracy of sources for MedRec in paediatrics are scarce in the United Kingdom. A few studies have shown that General Practice (GP) records do not match the patients’ current medicines lists in 29–45% of patients.2 3 The primary aim is to determine the accuracy of GP records in paediatric Med Rec, exploring types of discrepancies and any potential relationships between discrepancy rates and polypharmacy. The secondary aim is to audit compliance with local MedRec standard operating procedures (SOPs).

Methods

Prospective observational multicentre study (Site A: general district hospital; Site B: tertiary care hospital) that will take place over a 4 week period during three consecutive years. HRA approval was granted (IRAS ID 234128).

Participants received an age appropriate study information sheet and were consented to the study by pharmacy staff. Consent gave the researcher access to summary care record (SCR) and hospital records. All data was anonymised. Patients who were on no medicines at home, patients who had never been home, and those transferring from another Trust were excluded. Using the SCR, the patients’ GP repeat medication list was compared to the list compiled during MedRec by hospital pharmacy staff. Statistical relationships between polypharmacy and discrepancies were explored using the contingency Fisher’s Exact Test.

Results

63 patients were recruited- 27 patients (43%) on site A and 36 (57%) on site B. The study showed that the SCR did not match (medication omitted, differences in dose, frequency of formulation) the patient’s actual MedRec in 54 (86%) patients. Discrepancy rates per patient were higher at site B (94%, n=34) than site A (67%, n=18). The study included 347 medicines- 95 on site A (27%) and 252 (63%) on site B. The discrepancy rate looking at the total number of medicines included in the study was 51% (n=177). Overall, the most common type of discrepancy was ‘medication omitted’, accounting for 114 (64%) of discrepancies. Looking at the omitted medicines, 25 (22%) were unlicensed or off-label.

Fisher’s Exact Test showed an overall statistical significant relationship between polypharmacy and discrepancy rates (p=0.05). Only one source was used for MedRec in 32 (51%) of patients. In 2 (3%) of those patients that source were the patient’s own medicines, not the parent/patient/carer.

Conclusion

GP repeat lists on the SCR are not an accurate source in paediatric MedRec and should only be used to support another source. Discrepancy rates per patient were much higher compared to previous studies (86% vs 45%),2 3 and could have been overestimated as some GP surgeries do not add unlicensed medicines to the repeat section of the SCR. Only a small proportion of omitted medicines were unlicensed or off-label, suggesting licensing status on its own is not responsible for omissions.

A statistically significant relationship between polypharmacy and chance of discrepancy was found, but larger study numbers are needed. Local SOPs were not followed in a small number of patients (3% overall).

References

Aaronson, J. Medication Reconciliation. BMJ2017;356:i5336doi: 10.1136/bmj.i5336 (Published 2017 January 05). Available at: https://www.bmj.com/content/356/bmj.i5336?variant=full-text&hwoasp=authn%3A1522777001%3A203%3A182198391%3A0%3A0%3A%2BIxYJU7ZcUg%2FuHoqlVXa3w%3D%3D (Date accessed August 2018)

Terry D, Solanki G, Sinclair A, Marriott J, Wilson K. Clinical Significance of Medication Reconciliation in Children Admitted to a UK Pediatric Hospital. Pediatric Drugs. 2010;12(5):331–337.

Huynh C, Tomlin S, Jani Y, Solanki G, Haley H, Smith R, et al. An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Archives of Disease in Childhood. 2015;101(1):67–71.