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Research Article Open Access
Background: Medication reconciliation is the comprehensive evaluation of a patient’s medication regimen any time there is a change in therapy in an effort to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions, as well as to observe compliance and adherence patterns. The objective of this study was to determine the prevalence of medication discrepancies at discharge in St. Paul’s hospital millennium medical college.
Methods and findings: A prospective cross sectional study was conducted at St. Paul’s hospital millennium medical college from March 14 - May 14 2013. The medical chart was screened for all consecutive patients discharged from the general internal medicine ward prospectively. During the study period 111 eligible patients were included in the analysis. The Data were abstracted using modified medication reconciliation tool to assess discrepancy. From 111 observations 46(41.4%) had at least one unintended discrepancy at the time of discharge, and 13(11.7%) had more than one unintended discrepancy. The most common unintentional discrepancy was discrepant dosing of the medication (45.6%), followed by omission of medication (30.4%). Cardiovascular medications were the most frequent drug classes with discrepancy (63%).
Conclusions: Medication discrepancies are highly prevalent at hospital discharge with discrepant dosing of medication being identified as the most frequent type of medication discrepancy. Attention to the medication therapy and increased involvement of clinical pharmacists in the provision of pharmaceutical care are important measures.
Reconciliation, Medication discrepancy, Hospital, Medication error, Discharge, Medical trials, Clinical Trial, Clinical Data Management