Medication reconciliation OSCE — complex discharge counselling · Paeds Cases

Prompt

Station A is bedside reconciliation for a child with epilepsy and medical complexity. Station B is discharge counselling of a revised liquid regimen with teach-back.

Station objectives

Build a Best Possible Medication History from multiple sources. [1]
Classify intentional versus unintentional discrepancies and prioritise critical omissions. [21] [13]
Plan discharge reconciliation, liquid teaching and loop closure. [34] [3]
Address polypharmacy burden without blaming the caregiver. [6] [28]
Communicate medication changes clearly for handoff. [11]

Candidate brief

You are the paediatric doctor at a ward–discharge interface. You have 12 minutes for Station A and 10 minutes for Station B. Examiners score safety prioritisation, partnership language and concrete teaching. [1] [6]

Station A — Bedside reconciliation

Setup: Caregiver of an 8-year-old with epilepsy and medical complexity; bag of bottles; EHR list incomplete; recent specialty dose change. [13] [7]

Expected actions:

Explain why you are checking every medicine. [1]
Inspect bottles and ask dose, concentration, frequency, last dose and adherence. [1] [34]
Include OTCs, school doses and PRNs. [1]
Name missing critical therapy as a high-priority unintentional discrepancy. [13] [21]
Contact pharmacy/specialty as needed and document sources. [32] [1]
Avoid shaming language about “too many medicines.” [6] [28]

Station B — Discharge teach-back

Setup: Same child ready for discharge with at least one liquid medicine change; caregiver anxious. [34] [12]

Expected actions:

Confirm final list; remove temporary inpatient medicines if not indicated. [12] [4]
Teach liquid dose with oral syringe; state mg and mL with concentration. [34] [36]
Use teach-back; arrange interpreter if language discordance is present. [34]
Provide written list and follow-up owner/time to medical home. [3] [31]
State what to do if a dose is vomited or missed for critical medicines. [13]

Marking anchors

Clear pass: builds multi-source BPMH, prioritises critical unintentional gaps, teaches liquids with teach-back, closes loop. [1] [13] [34]
Borderline: correct ideas but no concentration/device teaching or no ownership for unresolved gaps. [34]
Fail: trusts EHR alone; ignores missing anticonvulsant; kitchen-spoon advice; blames caregiver for system polypharmacy. [1] [13] [6]

Debrief pearls

BPMH ≠ last discharge summary. [1]
Unintentional critical omission is urgent. [13]
Liquids need concentration + syringe + teach-back. [34]
CMC polypharmacy needs safer design, not shame. [6]

References

[1]Merandi, Jenna Medication Reconciliation. Pediatrics in review, 2017.PMID 28044039
[2]Sheth, Sarika Standardizing Medication Reconciliation in a Pediatric Emergency Department. Pediatrics, 2024.PMID 38273780
[3]Condren, Michelle Medication Reconciliation Across Care Transitions in the Pediatric Medical Home. Joint Commission journal on quality and patient safety, 2019.PMID 30898508
[4]Morse, Keith E Quantifying Discharge Medication Reconciliation Errors at 2 Pediatric Hospitals. Pediatric quality & safety, 2021.PMID 34345749
[5]Gunkelman, Samantha M Improving Accuracy of Medication Reconciliation for Hospitalized Children: A Quality Project. Hospital pediatrics, 2024.PMID 38529561
[6]Feinstein, James A Making Polypharmacy Safer for Children with Medical Complexity. The Journal of pediatrics, 2023.PMID 36252865
[7]Huth, Kathleen Medication safety for children with medical complexity. Paediatrics & child health, 2020.PMID 33178368
[8]Zanin, Anna Polypharmacy in Children with Medical Complexity: A Cross-Sectional Study in a Pediatric Palliative Care Center. Children (Basel, Switzerland), 2024.PMID 39062270
[9]Alqenae, Fatema A Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug safety, 2020.PMID 32125666
[10]Aires-Moreno, Giulyane Targino Medication discrepancies in transition of care of hospitalised children in Brazil: a multicentric study. Archives of disease in childhood, 2021.PMID 33958348
[11]Starmer, Amy J Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[12]Gattari, Theresa B Medication Discrepancies at Pediatric Hospital Discharge. Hospital pediatrics, 2015.PMID 26231634
[13]Louiselle, Katie Medication Discrepancy Risk Factors for Pediatric Patients With Epilepsy at Hospital Admission. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2021.PMID 34035684
[14]Moss, James G Paediatric polypharmacy and deprescribing: the views of UK healthcare professionals. Archives of disease in childhood, 2023.PMID 35701176
[15]Zito, Julie M Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary. Frontiers in psychiatry, 2021.PMID 34194346
[16]DeCourcey, Danielle D Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2017.PMID 28198758
[17]Huynh, Chi An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Archives of disease in childhood, 2016.PMID 26566687
[18]Huynh, Chi Medication discrepancies at transitions in pediatrics: a review of the literature. Paediatric drugs, 2013.PMID 23670796
[19]Huynh, Chi An evaluation of paediatric medicines reconciliation at hospital discharge into the community. The International journal of pharmacy practice, 2016.PMID 26670624
[20]Wong, Jacqueline D Medication reconciliation at hospital discharge: evaluating discrepancies. The Annals of pharmacotherapy, 2008.PMID 18780806
[21]Cornish, Patricia L Unintended medication discrepancies at the time of hospital admission. Archives of internal medicine, 2005.PMID 15738372
[22]Tam, Vincent C Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2005.PMID 16129874
[23]Kwan, Janice L Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine, 2013.PMID 23460096
[24]Mueller, Stephanie K Hospital-based medication reconciliation practices: a systematic review. Archives of internal medicine, 2012.PMID 22733210
[25]Coffey, Maitreya Prevalence and clinical significance of medication discrepancies at pediatric hospital admission. Academic pediatrics, 2009.PMID 19640822
[26]Kulawiak, Jessica Evaluation of a Pharmacist-Driven Discharge Medication Reconciliation Service Pilot at a Children's Hospital. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2024.PMID 39411418
[27]Grossberg, Richard Polypharmacy-An Important Contributor to Health and Safety for Children With Medical Complexity: How Can We Improve Care for This Vulnerable Population? The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2024.PMID 38596412
[28]Reedy, Julia Challenges of managing pediatric polypharmacy in a pediatric complex care program: A qualitative pilot study. Journal of the American Pharmacists Association : JAPhA, 2025.PMID 40127839
[29]Alcântara, Thaciana Dos Santos Prevalence of medication discrepancies in pediatric patients transferred between hospital wards. International journal of clinical pharmacy, 2021.PMID 33175294
[30]Kuo, Dennis Z Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[31]Kuo, Dennis Z Care Coordination for Children With Medical Complexity: Whose Care Is It, Anyway? Pediatrics, 2018.PMID 29496973
[32]Zennaro, Margherita Improving Medication Safety Through Medication Reconciliation in Pediatric Neurology: Clinical Pharmacist Recommendations and Physician Uptake in a 13-Week Study. Children (Basel, Switzerland), 2025.PMID 40426804
[33]Adducchio, Sara Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit. Neurology. Clinical practice, 2024.PMID 38524835
[34]Yin, H Shonna Preventing Home Medication Administration Errors. Pediatrics, 2021.PMID 34851406
[35]Yin, H Shonna Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study. Pediatrics, 2017.PMID 28759396
[36]Yin, H Shonna Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment. Academic pediatrics, 2016.PMID 27155289

Station objectives

Build a Best Possible Medication History from multiple sources. [1]

Classify intentional versus unintentional discrepancies and prioritise critical omissions. [21] [13]

Plan discharge reconciliation, liquid teaching and loop closure. [34] [3]

Address polypharmacy burden without blaming the caregiver. [6] [28]

Communicate medication changes clearly for handoff. [11]

Station A — Bedside reconciliation

Setup: Caregiver of an 8-year-old with epilepsy and medical complexity; bag of bottles; EHR list incomplete; recent specialty dose change. [13] [7]

Expected actions:

Explain why you are checking every medicine. [1]

Inspect bottles and ask dose, concentration, frequency, last dose and adherence. [1] [34]

Include OTCs, school doses and PRNs. [1]

Name missing critical therapy as a high-priority unintentional discrepancy. [13] [21]

Contact pharmacy/specialty as needed and document sources. [32] [1]

Avoid shaming language about “too many medicines.” [6] [28]

Station B — Discharge teach-back

Setup: Same child ready for discharge with at least one liquid medicine change; caregiver anxious. [34] [12]

Expected actions:

Confirm final list; remove temporary inpatient medicines if not indicated. [12] [4]

Teach liquid dose with oral syringe; state mg and mL with concentration. [34] [36]

Use teach-back; arrange interpreter if language discordance is present. [34]

Provide written list and follow-up owner/time to medical home. [3] [31]

State what to do if a dose is vomited or missed for critical medicines. [13]

Marking anchors

Debrief pearls

BPMH ≠ last discharge summary. [1]

Unintentional critical omission is urgent. [13]

Liquids need concentration + syringe + teach-back. [34]

CMC polypharmacy needs safer design, not shame. [6]

References

[1]Merandi, Jenna Medication Reconciliation. Pediatrics in review, 2017.PMID 28044039
[2]Sheth, Sarika Standardizing Medication Reconciliation in a Pediatric Emergency Department. Pediatrics, 2024.PMID 38273780
[3]Condren, Michelle Medication Reconciliation Across Care Transitions in the Pediatric Medical Home. Joint Commission journal on quality and patient safety, 2019.PMID 30898508
[4]Morse, Keith E Quantifying Discharge Medication Reconciliation Errors at 2 Pediatric Hospitals. Pediatric quality & safety, 2021.PMID 34345749
[5]Gunkelman, Samantha M Improving Accuracy of Medication Reconciliation for Hospitalized Children: A Quality Project. Hospital pediatrics, 2024.PMID 38529561
[6]Feinstein, James A Making Polypharmacy Safer for Children with Medical Complexity. The Journal of pediatrics, 2023.PMID 36252865
[7]Huth, Kathleen Medication safety for children with medical complexity. Paediatrics & child health, 2020.PMID 33178368
[8]Zanin, Anna Polypharmacy in Children with Medical Complexity: A Cross-Sectional Study in a Pediatric Palliative Care Center. Children (Basel, Switzerland), 2024.PMID 39062270
[9]Alqenae, Fatema A Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug safety, 2020.PMID 32125666
[10]Aires-Moreno, Giulyane Targino Medication discrepancies in transition of care of hospitalised children in Brazil: a multicentric study. Archives of disease in childhood, 2021.PMID 33958348
[11]Starmer, Amy J Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[12]Gattari, Theresa B Medication Discrepancies at Pediatric Hospital Discharge. Hospital pediatrics, 2015.PMID 26231634
[13]Louiselle, Katie Medication Discrepancy Risk Factors for Pediatric Patients With Epilepsy at Hospital Admission. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2021.PMID 34035684
[14]Moss, James G Paediatric polypharmacy and deprescribing: the views of UK healthcare professionals. Archives of disease in childhood, 2023.PMID 35701176
[15]Zito, Julie M Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary. Frontiers in psychiatry, 2021.PMID 34194346
[16]DeCourcey, Danielle D Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2017.PMID 28198758
[17]Huynh, Chi An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital. Archives of disease in childhood, 2016.PMID 26566687
[18]Huynh, Chi Medication discrepancies at transitions in pediatrics: a review of the literature. Paediatric drugs, 2013.PMID 23670796
[19]Huynh, Chi An evaluation of paediatric medicines reconciliation at hospital discharge into the community. The International journal of pharmacy practice, 2016.PMID 26670624
[20]Wong, Jacqueline D Medication reconciliation at hospital discharge: evaluating discrepancies. The Annals of pharmacotherapy, 2008.PMID 18780806
[21]Cornish, Patricia L Unintended medication discrepancies at the time of hospital admission. Archives of internal medicine, 2005.PMID 15738372
[22]Tam, Vincent C Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2005.PMID 16129874
[23]Kwan, Janice L Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine, 2013.PMID 23460096
[24]Mueller, Stephanie K Hospital-based medication reconciliation practices: a systematic review. Archives of internal medicine, 2012.PMID 22733210
[25]Coffey, Maitreya Prevalence and clinical significance of medication discrepancies at pediatric hospital admission. Academic pediatrics, 2009.PMID 19640822
[26]Kulawiak, Jessica Evaluation of a Pharmacist-Driven Discharge Medication Reconciliation Service Pilot at a Children's Hospital. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2024.PMID 39411418
[27]Grossberg, Richard Polypharmacy-An Important Contributor to Health and Safety for Children With Medical Complexity: How Can We Improve Care for This Vulnerable Population? The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2024.PMID 38596412
[28]Reedy, Julia Challenges of managing pediatric polypharmacy in a pediatric complex care program: A qualitative pilot study. Journal of the American Pharmacists Association : JAPhA, 2025.PMID 40127839
[29]Alcântara, Thaciana Dos Santos Prevalence of medication discrepancies in pediatric patients transferred between hospital wards. International journal of clinical pharmacy, 2021.PMID 33175294
[30]Kuo, Dennis Z Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[31]Kuo, Dennis Z Care Coordination for Children With Medical Complexity: Whose Care Is It, Anyway? Pediatrics, 2018.PMID 29496973
[32]Zennaro, Margherita Improving Medication Safety Through Medication Reconciliation in Pediatric Neurology: Clinical Pharmacist Recommendations and Physician Uptake in a 13-Week Study. Children (Basel, Switzerland), 2025.PMID 40426804
[33]Adducchio, Sara Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit. Neurology. Clinical practice, 2024.PMID 38524835
[34]Yin, H Shonna Preventing Home Medication Administration Errors. Pediatrics, 2021.PMID 34851406
[35]Yin, H Shonna Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study. Pediatrics, 2017.PMID 28759396
[36]Yin, H Shonna Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment. Academic pediatrics, 2016.PMID 27155289