title: [A case of complex discharge medication].
abstract: At discharge of a 72 year old epileptic patient from the hospital, the clinician prescribed the switch from Orfiril® to Lamictal®. The general practitioner misinterpreted the confusing medication list and made handwritten changes. Later on, family members of the patient observed a discrepancy between the handwritten comments of the general practitioner and the medication list of the clinician. The medication could be re-evaluated in cooperation with the hospital pharmacy and the general practitioner. An early interdisciplinary collaboration would help improving patient safety.
authors.affiliation: Spital-Pharmazie, Universitätsspital Basel. dbornand@uhbs.ch
authors.forename: D
authors.initials: D
authors.lastname: Bornand
authors.forename: C
authors.initials: C
authors.lastname: Surber
authors.forename: C
authors.initials: C
authors.lastname: Meier
authors.forename: H
authors.initials: H
authors.lastname: Plagge
mesh_terms: D000359:Aftercare; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage*; D017028:Caregivers / Q000193:education; D003299:Cooperative Behavior; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D058006:General Practice; D006236:Handwriting; D006801:Humans; D033183:Interdisciplinary Communication; D059065:Medication Reconciliation; D010351:Patient Discharge; D010353:Patient Education as Topic; D055656:Prescriptions / Q000592:standards
chemical_list: D000927:Anticonvulsants