Background: Medication reconciliation (MR) is critical for patient safety during hospital admissions and transitions, though MR completion may be complicated by factors such as lack of familiarity with the electronic medical record (EHR) or missing information at admission. Over the past three years, our urban academic quaternary care hospital has led a successful MR improvement [...]

Background: Medication reconciliation (MR) is critical for patient safety during hospital admissions and transitions, though MR completion may be complicated by factors such as lack of familiarity with the electronic medical record (EHR) or missing information at admission. Over the past three years, our urban academic quaternary care hospital has led a successful MR improvement [...]

Background: Medication reconciliation during admission is a critical step in ensuring patient safety and preventing medication errors, particularly as patients often receive new medications during their hospital stays. However, physicians may not always have access to a complete and accurate medication history, which can lead to risks such as drug interactions, incorrect dosing, or adverse [...]

Background: Medication reconciliation is a complex process intended to identify and resolve discrepancies by maintaining the most accurate medication list for a patient to provide ultimate care. The Joint Commission National Patient Safety Goals emphasize completion of medication reconciliation on admission within an organization to reduce the likelihood of harm to patients.1 Our medical center [...]

Background: Accurate, timely admission medication reconciliation (AMR) is a key patient-safety driver. Clinician-performed AMR has higher error rates compared to pharmacy-performed AMR. At our large, tertiary care institution, pharmacists capture only 75% of AMRs and require up to 48h for completion. Delays and errors in clinician-performed AMR on medicine floors have led to patient safety [...]

Background: Within 3 weeks of hospital discharge, about 19% of patients experience an adverse event, with 66% of these being an adverse drug event. During a patient’s transition from hospital to home, pharmacists have identified and resolved medication discrepancies. Inappropriate continuation or discontinuation of medications post-hospital discharge often stems from medication list complexity, inconsistent or [...]