Admission Medication Reconciliations in Pediatric Patients Admitted to an Inpatient Psychiatry Unit

Abstract

Objective: Medication errors resulting in adverse drug events may occur during transition of care. Most can be prevented with a medication reconciliation. California Senate Bill 1254 requires a pharmacist to perform an admission medication reconciliation (AMR) to obtain an accurate medication list for each high-risk patient upon hospital admission. Adult patient literature reveals that antidepressant, antipsychotic, and mood-stabilizing drugs are high-risk medications likely to cause errors. Therefore, the purpose of this analysis is to determine if pediatric psychiatry inpatients should be considered high risk, meriting an additional AMR by the pharmacy team.

Methods: This was a retrospective, single-center analysis of pediatric patients admitted to the inpatient psychiatry unit at Rady Children's Hospital, San Diego between January 1 and 31, 2021. All newly admitted patients had an AMR performed by the medical team (physician-led AMR). High-risk patients (prescribed a high-risk medication or 3 or more medications of any kind prior to admission) had an additional AMR by the pharmacy team (pharmacy-led AMR). Differences between these 2 AMRs were examined.

Results: Of the 58 patients admitted during the study period, 39 (67.2%) were identified as high risk, warranting an AMR by the pharmacy team. From the 170 medications reviewed, 51 differences (30%) were found between physician-led and pharmacy-led AMR, with 4 (2.4%) of the differences involving high-risk medications. No medications were incorrectly ordered, and no adverse drug events occurred.

Conclusions: Given that physician-led and pharmacy-led AMRs of high-risk prescription medications were only marginally different and no medications were incorrectly ordered, the existing AMR methodology used by psychiatrists at our institution is effective at creating a safe medication list.

Keywords: admission medication reconciliation; high-risk medications; high-risk patients; pediatric psychiatry; transition of care.