Many children need to take medication at home after being discharged from the hospital. Recent research conducted at the Children’s Hospital at Montefiore (CHAM) and Albert Einstein College of Medicine found that 70 percent of caregivers either mismanage or don’t fully understand hospital discharge medication instructions, leading to problems such as wrong dosage or confusion about side effects. Now, the same CHAM investigators looked at ways to correct this issue and published their results in Pediatrics. They found medication-related failures can be reduced by almost 50 percent when there is a standardized approach to discharging patients with medications.

“When caregivers are responsible for giving their children medicines at home, it can be confusing and stressful,” said lead author Kaitlyn Philips, DO, assistant medical director of Pediatric Quality, CHAM, and assistant professor of pediatrics, Albert Einstein College of Medicine. “We want children to continue to get better in the comfort of their own home, so it’s vital that caregivers can confidently and safely give medications. Our research shows that when we have a consistent way of educating caregivers, we can reduce the chance that mistakes will be made.”

Dr. Philips is part of a dedicated quality improvement team at CHAM, created to identify issues and implement sustainable fixes to reduce preventable harm and improve patient safety. Supported in part by National Institute of Health grants, she and several other CHAM and Einstein investigators are studying problems affecting patient-care delivery and developing solutions for them. Dr. Philips is also a scholar in the Learning Health System Center of Excellence at Einstein and Montefiore, which provides mentoring and training on how to use data to continuously improve the delivery of care.

For the Pediatrics study, Dr. Philips sought to improve parental knowledge about their child’s medication needs and create clearer instructions to follow at home. She developed and implemented a program called MEDRITES, which stands for:

• Medication name
• Engagement with the family
• Dose, Route, Indications and Timing
• Expected Effects and side Effects
• Storage counseling and Syringe for accurate administration

Over the 12-month intervention period, caregivers received bedside medication counseling where the provider discussed each topic in MEDRITES in depth. The family also took home improved documentation with clear instructions. Within a week of being discharged, investigators held phone interviews with 249 caregivers, asking how well they understood and were able to follow the discharge instructions. Compared to the 157 patient caregivers interviewed before the program, people who discussed MEDRITES and received improved take-home documentation had better understanding of their child’s medication needs.MEDRITES has been incorporated into another quality initiative at CHAM called “SAFER Care,” led by Audrey Uong, M.D., attending physician, CHAM, and assistant professor of pediatrics, Einstein. This initiative provides additional discharge guidance for families on topics including: how to prepare children to go back to school; when to follow up with their pediatrician; and what symptoms could indicate signs of relapse. Additionally, MEDRITES is incorporated into annual education for new doctors and several subspecialty providers are adopting a similar process for discharge medication counseling and documentation for their patients.“The MEDRITES initiative demonstrates that making simple changes, like rounding medication doses to amounts that are appropriate and safe, but also easier to measure, can have a big impact on how children are cared for at home,” said Dr. Philips. “We believe this intervention could be used at hospitals throughout the country to help prevent medication-related errors for children.”The manuscript is titled MEDRITES: A Project to Improve the Pediatric Inpatient Discharge Medication Process. It is co-authored by Roy Zhou, MD, Diana S. Lee, MD, Christine Marrese, MD, Joanne Nazif, MD, Constance Browne, PharmD, Mark Sinnett, PharmD, Steven Tuckman, BS Pharm, MBA, Anjali Modi, Michael L. Rinke, MD, PhD. The study was supported by the NIH/National Center for Advancing Translational Science (NCATS). 

### 

About Montefiore Health System Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.   About Albert Einstein College of Medicine

Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2020-21 academic year, Einstein is home to 721 M.D. students, 178 Ph.D. students, 109 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2020, Einstein received more than $197 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.