Paeds SAQs · clinical-assessment-and-reasoning
Medication reconciliation and polypharmacy in children — formative SAQs
Two formative short-answer questions on BPMH, discrepancy classification, CMC polypharmacy and discharge teaching.
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Target exams
SAQ 1 — Admission discrepancy in epilepsy (10 marks)
A 9-year-old with epilepsy is admitted with breakthrough seizures. The electronic list shows one anticonvulsant. The family bag contains two anticonvulsants and an old lorazepam bottle from a previous admission. [13] [17]
Questions
- Define Best Possible Medication History and list the sources you would use. (3 marks) [1]
- Classify the likely discrepancy types in this scenario and identify which is highest priority. (4 marks) [21] [13]
- State immediate reconciliation actions before writing ongoing inpatient orders. (3 marks) [1] [16]
Model answer
BPMH (3). A verified current medication list built from multiple sources, not a copied old discharge summary. Sources: caregiver interview; bottles/photos; pharmacy history; specialty letters; prior discharges/EHR. Capture name, concentration/strength, dose, route, frequency, indication, last dose and adherence. [1] [18]
Classification (4). Possible unintentional omission of the second anticonvulsant; possible commission if lorazepam is no longer indicated but still listed/used; possible wrong-dose risk if recent changes are missed. Highest priority is clarifying and restoring appropriate critical anticonvulsant therapy and stopping unsafe extras. Intentional changes need documentation; unexplained gaps are unintentional until proven otherwise. [21] [13] [12]
Immediate actions (3). Hold unsafe guessing; build BPMH same shift; contact neurology/pharmacy as needed; correct clinically important unintentional discrepancies before definitive ongoing orders; document sources and plan; treat seizures per acute pathway while the list is secured. [1] [16] [13]
SAQ 2 — CMC polypharmacy and discharge (10 marks)
A technology-dependent child with medical complexity is ready for ward discharge on 11 scheduled medicines and several PRNs. Mother coordinates all specialists alone and is unsure about two liquid concentrations. [6] [7]
Questions
- Explain how paediatric polypharmacy should be framed beyond a simple drug count. (3 marks) [6] [27]
- Outline a stepwise discharge reconciliation and teaching plan. (4 marks) [1] [34]
- List deprescribing and system actions that reduce long-term risk. (3 marks) [14] [3]
Model answer
Framing (3). In CMC, multiple medicines are common. Safety focuses on indication, effectiveness, interactions, administration burden, monitoring and avoidable cascades—not shaming a number alone. [6] [7] [27]
Discharge plan (4). Final BPMH versus discharge orders; remove temporary inpatient medicines; confirm each liquid concentration and oral syringe; teach-back with demonstration; provide written list; arrange supply; communicate final list to medical home/specialists; timed follow-up for unresolved issues. Use interpreter if language discordance. [1] [12] [34] [3]
Deprescribing/system (3). Review each medicine for ongoing indication; stop or taper what is no longer needed with a monitoring plan; reduce schedule complexity; engage pharmacist/complex-care coordination; close multi-prescriber loops so new starts do not silently accumulate. [14] [6] [31]
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