Medication reconciliation and polypharmacy in children — formative SAQs

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

1. Define Best Possible Medication History and list the sources you would use. (3 marks) ^[1]
2. Classify the likely discrepancy types in this scenario and identify which is highest priority. (4 marks) ^{[21] [13]}
3. 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]}