Background: Effective discharge communication is essential for reducing medication errors at home, a leading cause of harm that particularly impacts pediatric patients and caregivers with limited English proficiency (LEP). Little is known about the quality of provider communication of medications to patients and caregivers at the time of hospital discharge. Purpose: To characterize nurse communication of medications at the time of hospital discharge for hospitalized children. Methods: This was a cross-sectional study using direct structured observation of hospital discharges by trained observers at a freestanding children’s hospital. We included conveniently sampled discharge encounters of hospitalized pediatric patients (ages 0-18 years) and their caregivers with English proficiency (EP) or LEP. Quantitative measures on how nurses discussed discharge medications with hospitalized patients and caregivers were captured including review of medication name, dose, timing, frequency, duration, and route. Observers also noted whether nurses discussed medication access or if caregivers were made aware of special instructions (i.e. start, stop, or change medication) specified on written discharge documentation. We used descriptive statistics to assess encounter characteristics and medication components discussed. Results: A total of 103 discharge encounters were observed. Ninety-one encounters (61% EP vs 39% LEP) had discharge medications (Table 1); nurses verbally reviewed medications in some capacity 98% of the time and discussed medication access 75% (79% EP vs 69% LEP) of the time. Total number of medications was 461 (mean 4.5 per encounter); the most common medication classes were pain relievers (27%), gastrointestinal medications (15%) and antimicrobials (13%) (Table 2). Of the 461 medications, 69% were verbally discussed in any capacity (71% EP vs 65% LEP). Medication name, frequency and timing were the most frequently communicated medication components (63%, 36%, and 26% respectively) while dose, duration and route of medications were communicated less often (13%, 9% and 9%). Of the medications with special instructions specified on written documentation, nurses discussed stopping, starting and changes to medications 49%, 19% and 18% of the time respectively. Conclusions: Nursing verbal communication of discharge medications to patients and caregivers was inconsistent, and at times instructions were incomplete. Future work should include standardizing medication communication at the time of pediatric discharge to improve medication adherence and understanding and reduce the likelihood of medication errors.
1 Other race included Middle Eastern, Asian, Latino, and Unknown as denoted in Electronic Health Record (EHR) 2 Other languages included Chinese (1), Korean (1), Japanese (1), Arabic (1), Russian (2), French (1), Nepali (4), Burmese/ Hakha Chin (1), and German (1) 3 Included patients and caregivers having medication in hand or verified pharmacy information
Table 2: Medication components discussed verbally: total number of discharge medication n=461 (n=274 for EP and n=187 for LEP)
1 Percentages are calculated out of total number of discharge medications