Background: Medication errors are common, with more than half of patients estimated to have greater than or equal to one unintended medication discrepancy at hospital admission.  Medication reconciliation can identify errors. Although there has been significant investigation into the most effective logistical strategies for performing medicine reconciliation within the healthcare system, there is little investigation [...]

Background: Adverse drug events (ADEs) are responsible for up to 770,000 inpatient injuries and deaths annually in the United States, most of which are from prescribing errors. Electronic order sets are designed to improve quality by reducing care variability and increasing efficiency of order entry, but may also facilitate prescribing errors via automation bias. There [...]

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: Patients are discharged home on medications different than those they were taking before admission.  New and discontinued medications as well as dosage changes contribute to medication-related adverse events.  Purpose: To help address this problem, interns in our program developed a standard process during their quality improvement (QI) curriculum to ensure that at least 95% [...]

Background: Transitioning patient care between hospitals and skilled nursing facilities (SNFS) brings many challenges.  Patient and family anxiety, unfamiliarity and even misinformation about SNFs increase the opportunity for unsatisfactory outcomes and readmissions to the hospital..  Previous research has demonstrated frequent and potentially harmful medication discrepancies during hospital to nursing home transitions, and low frequency of [...]

Background: The Joint Commission (TJC) included medication reconciliation (MedRec) as a 2005 National Patient Safety Goal to reduce errors related to medication omissions, duplications and interactions. Medication errors and harms continue to be one of the most widely reported healthcare problems. TJC’s sentinel event database includes > 350 medication errors resulting in death or major [...]

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: Obtaining the Best Possible Medication History (BPMH) is the protocolized gold standard in obtaining medication histories and well known to decrease the total number of medication errors during transitions in care. Trained technicians require an average of 15-30 minutes to collect a BPMH [2]. Our facility conducted a categorical analysis and within subject study [...]

Background: Medication reconciliation programs are a well-recognized important tool in reducing medication discrepancies and subsequently decreasing patient harm, particularly at transitions of care. Medication reconciliation programs have demonstrated error reductions upward of 66% [1-4]. 39% of prescription medication history errors have the potential to cause moderate or severe discomfort or deterioration in a patient’s condition [...]

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 [...]