Not Just a Box to Click: Improving Fidelity of Pediatric Medication Reconciliation
Poster #: 003
Session/Time: B
Author:
Lindsey Hill, BS
Mentor:
John Harrington, MD
Research Type: Quality Improvement
Abstract
INTRODUCTION:
Medication reconciliation (MR) is a critical patient safety process designed to ensure accurate prescribing and reduce adverse drug events. In pediatrics, MR requires caregiver-reported histories, frequent adjustments of medications, and transitions between care teams. Although electronic health records often show high MR completion rates, these metrics may overstate the true accuracy of MR. At Children's Hospital of The King's Daughters (CHKD), internal review confirmed high MR documentation, yet provider observations indicated persistent discrepancies. This disconnect between completion and fidelity of MR prompted a quality improvement (QI) initiative to enhance MR accuracy in pediatric patients.
METHODS:
MR quality was measured by averaging the congruence of medication entries across three chart sources: the Medication List, External SureScripts Rx History, and the physician's reconciled list from the encounter. A baseline accuracy rate was established via retrospective review of 120 charts from patients taking more than three medications seen at the General Academic Pediatric (GAP) practice over a two-week period in May 2025. As interventions were implemented, charts meeting the same criteria were reviewed to assess changes in MR quality over time. Interventions included (1) updating forms for families to report home medications, (2) educating GAP attendings about MR expectations, and (3) delivering targeted education to rotating residents.
RESULTS:
Post-intervention, overall MR accuracy increased from a baseline of 70% to 83% (p<0.001). Reductions were observed across multiple common error types including unreconciled charts, omissions, duplicate entries, and outdated medications.
CONCLUSION:
This QI initiative at CHKD demonstrated that targeted interventions can significantly improve MR accuracy. Enhancing provider awareness and standardizing documentation tools proved effective in reducing common sources of error and promoting safer, more accurate prescribing, especially for complex pediatric patients.
Medication reconciliation (MR) is a critical patient safety process designed to ensure accurate prescribing and reduce adverse drug events. In pediatrics, MR requires caregiver-reported histories, frequent adjustments of medications, and transitions between care teams. Although electronic health records often show high MR completion rates, these metrics may overstate the true accuracy of MR. At Children's Hospital of The King's Daughters (CHKD), internal review confirmed high MR documentation, yet provider observations indicated persistent discrepancies. This disconnect between completion and fidelity of MR prompted a quality improvement (QI) initiative to enhance MR accuracy in pediatric patients.
METHODS:
MR quality was measured by averaging the congruence of medication entries across three chart sources: the Medication List, External SureScripts Rx History, and the physician's reconciled list from the encounter. A baseline accuracy rate was established via retrospective review of 120 charts from patients taking more than three medications seen at the General Academic Pediatric (GAP) practice over a two-week period in May 2025. As interventions were implemented, charts meeting the same criteria were reviewed to assess changes in MR quality over time. Interventions included (1) updating forms for families to report home medications, (2) educating GAP attendings about MR expectations, and (3) delivering targeted education to rotating residents.
RESULTS:
Post-intervention, overall MR accuracy increased from a baseline of 70% to 83% (p<0.001). Reductions were observed across multiple common error types including unreconciled charts, omissions, duplicate entries, and outdated medications.
CONCLUSION:
This QI initiative at CHKD demonstrated that targeted interventions can significantly improve MR accuracy. Enhancing provider awareness and standardizing documentation tools proved effective in reducing common sources of error and promoting safer, more accurate prescribing, especially for complex pediatric patients.