Evaluation of a Patient Medication List for Ambulatory Pediatric Patients with in a Hospital-Based Complex Care Service

Abstract

Medication errors are common in the pediatric outpatient setting, with a reported preventable adverse drug event rate of 3 per 100 patients, and children with multiple prescriptions are at increased risk. Since 2005, medication reconciliation in the hospital setting has been an international patient safety priority, but little is known about its application in the ambulatory setting. The objective was to evaluate a novel Patient Medication List (PML) created for medically complex children with special health needs based on its usability, perceived ability to increase medication knowledge, and content. Caregivers of children followed by a tertiary care hospital ambulatory Complex Care Service from February to November 2009 were enrolled. An electronic PML software was programmed and nested within a comprehensive clinical program database. At the clinic visit, the medications were updated in the database by a nurse practitioner, and a PML was automatically created and printed for the caregivers. Caregivers completed 2 questionnaires, one prior to using the PML and the second 12 wks later. Results from Questionnaire 1 (n=27) showed that 18 (67%) caregivers expected the PML to be very helpful and 9 (33%) somewhat helpful. 18 (67%) and 21 (78%) caregivers expected the PML to be very helpful at clinic visits and at hospital admission respectively. When asked if the PML will increase their knowledge of their child's medications, 17 (63%) agreed, and 16 (59%) agreed the PML will help them to remember to administer medications at home. 15 of 26 (58%) caregivers already used a similar list. Preliminary results from Questionnaire 2 (n=11) showed that 8 (73%) caregivers found the PML very helpful. However, only 5 (45%) agreed that the PML increased their knowledge about their child's medication and 2 (18%) agreed the PML helped them to remember to administer medications at home. 10 (91%) agreed the PML contains all the necessary information. Informal staff feedback suggests there was a large time investment in the initial implementation, but once integrated into workflow, the PML was easy to use. In conclusion, parental caregivers for patients in a hospital-based Complex Care Service reported a Patient Medication List is helpful during interactions with their medical team, but it is less helpful in increasing their medication knowledge or reminding them to administer their child's medications at home.