An evaluation of paediatric medicines reconciliation at hospital discharge into the community

Chi Huynh, Ian Chi Kei Wong, Stephen Tomlin, Ellisha Halford, Yogini Jani, Maisoon Ghaleb

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting.

METHODS: Five weeks prospective review of hospital discharge letters was carried out. Medication discrepancies between the initial doctor's discharge letter and finalised drug chart were identified, pharmacist changes were recorded and their severity was assessed. The setting of the review was at a London, UK paediatric hospital providing local secondary and specialist tertiary care. The outcome measures were: - incidence and the potential clinical severity of medication discrepancies identified by the hospital pharmacist at discharge.

KEY FINDINGS: 142 patients (64 female and 78 males, age range 1 month - 18 years) were discharged on 501 medications. The majority of patients were under the care of general surgery and general paediatric teams. One in three discharge letters contained at least one medication discrepancy and required pharmacist interventions to rectify prior to completion. Of these, 1 in 10 had the potential for patient harm if undetected.

CONCLUSIONS: Medicines reconciliation by pharmacist at discharge may be a good intervention in preventing medication discrepancies which have the potential to cause moderate harm in paediatric patients.

Original languageEnglish
Pages (from-to)196-202
Number of pages7
JournalInternational Journal of Pharmacy Practice
Issue number3
Early online date15 Dec 2015
Publication statusPublished - May 2016

Bibliographical note

This is the peer reviewed version of the following article: Huynh, C., Wong, I. C. K., Tomlin, S., Halford, E., Jani, Y., & Ghaleb, M. (2016). An evaluation of paediatric medicines reconciliation at hospital discharge into the community. International Journal of Pharmacy Practice, 24(3), 196-202, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving


  • discharge
  • interface issues
  • medication risk
  • patient safety
  • medicines reconciliation


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