Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors

Aranha, Gabriela Almeida; Cruz, Andréia Cascaes; Pedreira, Mavilde da Luz Gonçalves

doi:10.1590/0034-7167-2021-0755

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (2) • 2023 • https://doi.org/10.1590/0034-7167-2021-0755 copy

Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors

Conciliación medicamentosa en pediatría: validación de instrumentos para la prevención de errores en la medicación

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to develop and validate the content of two instruments for promoting medication reconciliation for the transition of care of hospitalized children.

Methods:

methodological study, conducted in five stages: scope review for conceptual structure; elaboration of the initial version; content validation with five specialists using the Delphi technique; reassessment; and construction of the final version of the instruments. A content validity index of at least 0.80 was adopted.

Results:

three rounds of evaluation were carried out to reach the validity index of the proposed contents, whereas a new analysis of 50% of the 20 items of the instrument aimed at families, and 28.5% of the 21 items aimed at professionals was necessary. The instrument aimed at families reached an index of 0.93, and the instrument for professionals, 0.90.

Conclusions:

the proposed instruments were validated. It is now possible to proceed with practical implementation studies to identify their influence on safety during medication reconciliation at transition of care.

Descriptors:
Medication Reconciliation; Patient Safety; Pediatrics; Medication Errors; Professional-Family Relations.

Items	1^st round	2^nd round	3^rd round
1 Instrument title	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
2 Introductory message to the family	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
Identification data
3 Child’s name	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
4 Age	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
5 Diagnosis(es)	0.60	0.60^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
6 Current date	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
7 Name of custodian	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
8 Comorbidities	-	-	1.00^ Item already reflecting judges’ suggestion;
Child Allergy Information
9 Drug Allergy	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
10 Food Allergy	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
11 Warning message to the family	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
Chart with information about the drugs
12 Prescription	0.80	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
13 Administration	0.60	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
14 Method of preparation/administration	0.80	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
15 Chart Layout	0.40	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
Information on the use of teas and herbal medicines by the child
16 Use of teas	0.60	0.80^ Item already reflecting judges’ suggestion;	0.80^* * Item validated in the previous round.
17 Use of herbal medicines	0.60	0.80^ Item already reflecting judges’ suggestion;	0.80^* * Item validated in the previous round.
18 Open field for describing questions, doubts, and considerations of the family	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
Identification of the professionals who carried out the reconciliation process
19 First identification	0.60	0.80^ Item already reflecting judges’ suggestion;	0.80^* * Item validated in the previous round.
20 Second identification	0.60	0.80^ Item already reflecting judges’ suggestion;	0.80^* * Item validated in the previous round.
Global content validity index	0.80	0.91	0.93

Items	1^st round	2^nd round	3^rd round
1 Instrument title	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
Identification data
2 Child’s name	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
3 Date of Birth	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
4 Age	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
5 Weight	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
6 Height	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
7 Name of custodian	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
8 Diagnosis(es)	0.60	0.80^ Item already reflecting judges’ suggestion;	1.00
9 Current date	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
10 Patient’s place of origin	0.80	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
11 Comorbidities	-	-	1.00^ Item already reflecting judges’ suggestion;
12 Child Allergy Information	1.00	0.80^ Item already reflecting judges’ suggestion;	0.80^* * Item validated in the previous round.
Chart with information about the prescription and medication reconciliation
13 Prescription	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
14 Conducts	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
15 Drugs destined for home use	1.00	1.00^* * Item validated in the previous round.	1.00^* * Item validated in the previous round.
16 Chart Layout	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
Information on the use of teas and herbal medicines by the child
17 Use of teas	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
18 Use of herbal medicines	0.80	0.80^* * Item validated in the previous round.	0.80^* * Item validated in the previous round.
19 Open field for observations	0.80	0.80	0.80^* * Item validated in the previous round.
Identification of the professionals who carried out the reconciliation process
20 First identification	0.80	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
21 Second identification	0.80	1.00^ Item already reflecting judges’ suggestion;	1.00^* * Item validated in the previous round.
Global content validity index	0.86	0.89	0.90

Item	Judges’ comments/suggestions
Instrument aimed at Families
5	Replace "Main Diagnosis" with “Diagnosis(es)".
8	Include the item “Comorbidities”.
12	Replace "frequency" with "How many times a day?”.
12	Replace "fasting", "breakfast", "lunch”, and "dinner" meals with "morning", "afternoon”, and "evening" periods.
13	Replace the term "administration" with "at what time does he take it?"
14	Replace “Method of preparation" with “How to prepare it?".
15	Replace the chart’s background color.
16/17	Add “When was the last time he took it?”.
16/17	Remove "usage recommendations".
19/20	Change the data presentation.
19/20	Include the professional's "unit/sector".
Instrument aimed at Professionals
8	Replace "Main Diagnosis" with “Diagnosis(es)".
10	Change to universal inpatient units.
10	Add “others”.
11	Include the item “Comorbidities”.
12	Replace "drug allergy" with "allergies".
20/21	Change the data presentation.
20/21	Include the professional's "unit/sector".

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[1] Corresponding author: Gabriela Almeida Aranha, E-mail: gabriela.aranha@unifesp.br