Discharge Medication Reconciliation At The First Pediatric Cardiothoracic Post-Operative Clinic Visit Ada Koch, PharmD and Carrie Miller, RN Department of Pharmacy Department of Thoracic & Cardiovascular Surgery Confidential: For Quality Improvement Purposes Only

Project Aim Statement We aim to familiarize the parents of pediatric post-operative cardiovascular patients with their children’s medication regimen, specifically the medication name, dose and frequency. Confidential: For Quality Improvement Purposes Only

Project Aim Statement At discharge from the hospital, the post-operative medication regimen will be reviewed with each parent by the Pediatric Clinical Pharmacist. A list of the medications will be provided to the parent at this time. At the first post-operative cardiac clinic visit, the parents will be asked to state the medication name, dose, and frequency to ensure parent understanding of the medication regimen. Goal: Parent will correctly recollect the medication name, dose, and frequency. Target: 100% compliance Confidential: For Quality Improvement Purposes Only

Solutions Implemented Implemented March 2007: PRIOR TO DISCHARGE (AT THE HOSPITAL): 1. Discharge Medication Sheet – provided to all pediatric cardiothoracic surgery patients. A copy will be e-mailed to nurse practitioner at discharge. 2. All prescriptions are filled/called in to patient’s pharmacy prior to discharge. Insurance issues are identified and solved. 3. Discharge medication teaching provided to all parents/patients. Parents asked to verbally state regimen/show how to draw-up a correct dose. Provide parents with oral administration devices. THE FIRST POST-OP CLINIC VISIT: 1. The pediatric nurse practitioner reviews all scheduled medications with parent at the first post-op clinic appointment. 2. Parents to verbally state regimen – medication, dose and frequency. The pediatric nurse practitioner fills out data collection sheet. Confidential: For Quality Improvement Purposes Only

Discharge Medication Sheet Example Loyola University Medical Center Ronald McDonald Children’s Hospital 2160 South First Avenue Maywood, IL 60153 September 5, 2000 Osco Pharmacy (Elmhurst, IL): 630-111-1111 (phone) 630-111-1111 (fax) PATIENT’S NAME Weight: 4.8 kg Medication Administration Times Furosemide (Lasix) 10 mg/mL Solution Give 5 mg (0.5 mL) by mouth twice a day To help heart beat easier/remove fluid 8 am 8 pm Ranitidine (Zantac) 15 mg/mL Syrup Give 15 mg (1 mL) by mouth twice a day For stomach acid/reflux Keep all medications out of reach of children! Confidential: For Quality Improvement Purposes Only

Confidential: For Quality Improvement Purposes Only

Analysis As of February 2008, nine pediatric cardiothoracic surgery patients were followed from hospital discharge to their first clinic visit. Parents of eight patients were able to correctly recollect the prescribed regimen at their first post-operative visit. One parent could correctly state dose and frequency, but could not pronounce medication names. All nine parents stated that they found discharge medication sheet very helpful. Confidential: For Quality Improvement Purposes Only

Next Steps Continue discharge medication education for the parents of pediatric cardiovascular patients Develop a plan to expand discharge medication teaching to other pediatric populations. Confidential: For Quality Improvement Purposes Only