ABSTRACT
Introduction: With unintended medication discrepancy rates ranging from 30% to 70%, a formal discharge medication reconciliation process must be developed. One strategy shown to reduce medication errors is a pharmacist medication review at discharge. The purpose of this study is to determine the impact of a pharmacist-driven discharge medication reconciliation program.
Methods: The intervention group included pharmacist-reviewed patients with a high risk of unplanned readmission score and had a discharge order signed during a 2-month period. The control group included eligible patients who were not reviewed by a pharmacist. The after-visit summaries for both groups were then reviewed for additional medication discrepancies.
Results: This study included 140 patients, with 70 patients in each group. A total of 176 discrepancies were identified in the intervention group and 235 were found in the control group. The median number of discrepancies per patient was not statistically different between groups (2 vs. 2, p-value = .196). There were 22 and 24 30-day hospital readmissions in the intervention and control groups, respectively (p-value = .857).
Conclusions: More medication discrepancies were identified in the control group compared to pharmacist-reviewed patients. More robust studies including a pharmacist dedicated to discharge medication reconciliation should be conducted to identify the potential benefit.