title: Medication Errors Despite Using Electronic Health Records: The Value of a Clinical Pharmacist Service in Reducing Discharge-Related Medication Errors.
abstract: BACKGROUND
  Medication errors continue to exist despite the use of electronic health records and electronic prescribing; patient-centered medication reconciliation is important to decrease errors.
  
  
  OBJECTIVE
  To identify whether a team-based approach with a pharmacist performing medication management and discharge medication reconciliation will reduce discharge-related medication errors in an academic tertiary care hospital already using an electronic health record and computerized physician order entry.
  
  
  METHODS
  Prospective nonrandomized controlled trial.
  
  
  METHODS
  All patients were admitted to 2 of the 6 medicine teams from August 1, 2012, through October 31, 2012.
  
  
  METHODS
  On the intervention team, a pharmacist assisted with medication management, medication reconciliation, and medication education upon discharge. Although the physicians on the control team had access to a pharmacist, they rarely collaborated with the pharmacist. The numbers of discharge-related medication discrepancies on the intervention and control teams were compared.
  
  
  RESULTS
  Collaboration with a pharmacist reduced discharge-related medication errors. The percentage of patients without medication errors within 72 hours of discharge was 93.8% on the intervention team compared with 40.2% on the control team (P < .0001).
  
  
  CONCLUSIONS
  Pharmacist's involvement in the patient care team improved patient safety by decreasing discharge medication errors caused by using electronic health records and computerized physician order entry.
authors.affiliation: Internal Medicine, Veterans Affairs Medical Center (Drs Alex and Adenew), Hospital Medicine, Medical Service Department, Veterans Affairs Medical Center, and Georgetown University Hospital, George Washington University Hospital, Uniformed Services University of the Health Science (Dr Arundel), Veterans Affairs Medical Center (Dr Maron), and Hospital Medicine, Medical Service Department, Department of Veterans Affairs, and George Washington University, Uniformed Services University of the Health Science (Dr Kerns), Washington, District of Columbia.
authors.forename: Sumana
authors.initials: S
authors.lastname: Alex
authors.forename: Ayne B
authors.initials: AB
authors.lastname: Adenew
authors.forename: Cherinne
authors.initials: C
authors.lastname: Arundel
authors.forename: David D
authors.initials: DD
authors.lastname: Maron
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Kerns
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000458:organization & administration*; D008875:Middle Aged; D010351:Patient Discharge; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010820:Physicians; D014481:United States; D014493:United States Department of Veterans Affairs