title: Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland. tgrimes@rcsi.ie
authors.forename: T
authors.initials: T
authors.lastname: Grimes
authors.forename: T
authors.initials: T
authors.lastname: Delaney
authors.forename: C
authors.initials: C
authors.lastname: Duggan
authors.forename: J G
authors.initials: JG
authors.lastname: Kelly
authors.forename: I M
authors.initials: IM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data*; D004282:Documentation / Q000706:statistics & numerical data*; D004346:Drug Information Services / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008508:Medication Errors; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care