Background: Medication discrepancies, defined as unexplained differences between documented medication regimens, are highly prevalent in the hospital setting and an important contributor to adverse drug events.  In the hospital setting, 27% of all prescribing errors occur as a result of inaccurate medication histories at the time of admission. Pharmacist-recorded medication histories have been shown to result [...]

Background: With growing importance placed on patient safety, it has become necessary to elevate past processes and rethink rolls for experienced healthcare professionals. One of the primary goals identified by The Joint Commission is to “maintain and communicate accurate patient medication information” to “safely prescribe medications in the future” [1]. This task is often complicated [...]

Background: Medication discrepancies are prevalent at various transitions of care including hospital discharge. Medication changes at hospital discharge may be misunderstood by the patient or not conveyed throughout the healthcare system. Most outpatient pharmacy medication records were created for the sole purpose of dispensing prescriptions. Pharmacists have little incentive to remove outdated medications and are [...]