High Incidence of Medication Errors Following Hospital Discharge Shown in Pediatric Epilepsy

Discharge medication education was not shown to significantly reduce incidence of medication errors and their harm potential following hospital discharge among pediatric patients with epilepsy, according to findings published in Pediatric Neurology.

Characterized by researchers as a high-risk period for medication errors, the transition of care from inpatient to outpatient represents a time of change in medication management for children, in which an estimated 26% to 33% of pediatric patients have at least one medication error at hospital discharge. Moreover, it is estimated that 10% of discharge medication errors have the potential to cause patient harm.

“The risk for medication errors during transitions of care may be higher in medically complex patients such as those with epilepsy,” noted the study authors. “Pediatric patients with epilepsy often require multiple antiepileptic drugs (AEDs) to gain seizure control and have high rates of hospital readmission. These factors contribute to particularly complex medication regimens that change frequently, making care transitions intricate and time consuming.”

Seeking to better understand the proportion of patients with epilepsy who experience medication-related problems after inpatient admission, and whether a targeted discharge education intervention may impact the occurrence of these medication-related problems, they conducted a retrospective cohort study of data from a single academic medical center.

Pediatric patients who were aged 21 years or less, had a diagnosis of epilepsy or seizure-related disorder, were admitted to the general pediatric unit or pediatric intensive care unit for electroencephalographic monitoring, had increased seizure frequency, or had status epilepticus, were eligible for inclusion.

The study cohort was split into 2 groups, with cohort 1 consisting of a control group and cohort 2 consisting of patients who received discharge medication education, enrolled in a 2:1 ratio. For the discharge education consult service, the pharmacist reviewed the patient's medications and then created a personalized medication list, which includes medication calendars as applicable, with the patient and family then educated.

“Pharmacists routinely demonstrate use of all medical devices to patients using the teach-back method. The pharmacist then documents this interaction via a note in the electronic medical record,” explained the study authors.

The medical record was reviewed from hospital discharge to outpatient neurology follow-up to identify medication problems that occurred. The primary outcome was the difference in proportion of medication problems between the cohorts, with secondary outcomes including incidence of medication problems with harm potential, overall incidence of medication problems, and 30-day epilepsy-related readmissions.

A total of 221 patients were included in the analysis, with similar baseline demographics shown between the control cohort (n = 163) and the discharge education cohort (n = 58), except for racial distribution. Epilepsy diagnosis and admission reason were also similar, with electroencephalographic monitoring and increased seizure frequency cited as the most common admission reasons in both cohorts.

Findings indicated that the incidence of medication problems was not significantly different  between the control cohort and discharge education cohort (29.4% vs 24.1%; P = .44). Medication problems with harm potential were 25.6% lower in the discharge education cohort than the control group, but the difference also did not meet statistical significance (54.2% vs 28.6%; P = .131).

The most common type of medication problem with harm potential was mismatch dose (n = 12 [40%]), followed by mismatch directions (n = 5 [16.7%]), requires prior authorization (n = 4 [13.3%]), mismatch drug (n = 3 [10%]), prescription not sent (n = 3 [10%]), and unclear directions (n = 3 [10%]).

Furthermore, the most common AEDs at discharge were clobazam, felbamate, lamotrigine, levetiracetam, and valproic acid, in which the control cohort and the discharge education cohort showed differences in prescriptions for corticotropin (0% vs 6.9%; P = .005) and lacosamide (9.8% vs 20.7%; P = .033). Additionally, length of hospital stay was different between the cohorts with a median stay of 1 day in the control cohort and 2 days in the discharge education cohort (P = .003)

Researchers noted that the quality of the data in the electronic medical record, which is limited, for the retrospective study design may serve as a potential limitation of the findings. Moreover, they added that the study was underpowered due to low enrollment of pediatric patients with epilepsy in the discharge education cohort, which may have limited the ability to identify an impact of the discharge education intervention.

“This study demonstrated that pediatric patients with epilepsy experience a high percentage of medication errors after hospital discharge,” concluded study authors.

“Discharge education alone was not enough to impact medication errors in pediatric patients with epilepsy, and further intervention is needed. Interventions should focus on discharge programs that target review of medication prescribing.”

Reference

Kulawiak J, Miller JA, Hovey SW. Incidence of medication-related problems following pediatric epilepsy admissions. Pediatr Neurol. 2023 Feb 3;142:10-15. doi:10.1016/j.pediatrneurol.2023.01.015