Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care.

BACKGROUND: Medication discrepancies at the time of hospital discharge are common and can result in error, patient/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events. AIMS: To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital.
METHODS: This was an observational study of 139 cardiology patients admitted over a 3 month period during which a pharmacist prospectively recorded details of medication inconsistencies.
RESULTS: A discrepancy in medication documentation at discharge occurred in 10.8% of medication orders, affecting 65.5% of patients. While patient harm was assessed, it was only felt necessary to contact three (2%) patients. The most common inconsistency was drug omission (20.9%).
CONCLUSIONS: Inaccuracy of medication information at hospital discharge is common and compromises quality of care.