BACKGROUND Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and fol...

BACKGROUND The aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Addi...

BACKGROUND The role of the clinical pharmacist within the healthcare system remains unclear. OBJECTIVE Our objective was to describe a pharmacist's comprehensive geriatric assessment (pCGA) at admission of elderly patients and to assess its relevance in terms of medication compliance and pharmacist interventions (PIs). METHODS We conducted a prospective interventional study over 29 months i...

BACKGROUND AND OBJECTIVES A first step in reducing medication errors is for health care workers to be aware of a patient's medications, allergies, and any previously documented adverse drug events (ADEs). This study sought to determine the frequency of medication and allergy/ADE-related discrepancies in a family medicine residency clinic. METHODS Patients were contacted prior to appointments ...

PURPOSE A study was conducted to identify discrepancies between medication histories taken by emergency department (ED) providers (physicians, nurses, and medical students) and medication histories taken by clinical pharmacists. METHODS During a three-month period, a clinical pharmacist was assigned to the ED in a 475-bed, tertiary care teaching facility that serves as a level I trauma center...

Medication errors are among the most common type of patient-safety error and therefore are a priority for organizational performance-improvement efforts. Medication reconciliation has been found to greatly reduce adverse drug and medication events. At one facility, a computer-generated Physician Discharge Medication Worksheet (PDMW) was developed to aid medication reconciliation. Use of this to...