Background: Multiple safety reports were reviewed for missed doses of critical medications on admission to the inpatient rehabilitation units at a large academic medical center. It was found that providers were inconsistently or incorrectly using the admission medication reconciliation (AdmMedRec) functionality in EHR that could have prevented these errors.Many hospitals struggle with AdmMedRec due to [...]

Background: There are over 35 million discharges from inpatient hospitalizations annually in the US. During these transitions of care, patients are at risk for adverse events. It is crucial for patient safety to have accurate communication between the inpatient physician and the provider assuming care.The main conduit for this communication is the hospital discharge summary. [...]

Background: Medication errors during hospital discharge can lead to adverse outcomes, medication-related readmissions, and increased healthcare costs [1,2]. Pharmacist-led medication reconciliation at discharge (PMRD) has emerged as a potential solution to mitigate poor outcomes and optimize medication safety [3-7]. The main objectives of this study were to determine the number of errors identified at discharge [...]

Background: Critical illness requires initiation of several classes of medications to treat or prevent different conditions. These include nebulizers, PPIs, antipsychotics, antibiotics, steroids, anticoagulants, opioids, benzodiazepines, & several others. Continuation of these medications upon transfer from MICU to the floor is a common occurrence with downstream implications including side effects or potential harm to patients, [...]

Background: Medication reconciliation (MR) is foundational to patient safety during and after a hospital admission. Frequently, MR can be delayed at the time of hospital admission due to incomplete records, patient health literacy, barriers to patient communication such as language or mental status, and unavailability of family or primary care providers. Electronic health records (EHR) [...]

Background: Ensuring compliance with CMS requirements for inpatient admission orders and improving medication reconciliation at discharge are crucial aspects of patient safety and regulatory adherence. However, challenges such as missing admission orders and medication errors during transitions of care persist. In response, we implemented two strategic EHR interventions, Best Practice Advisories (BPAs), to enhance workflows, [...]