title: Prescribing error at hospital discharge: a retrospective review of medication information in an Irish hospital.
abstract: BACKGROUND
  Prescribing error may result in adverse clinical outcomes leading to increased patient morbidity, mortality and increased economic burden. Many errors occur during transitional care as patients move between different stages and settings of care.
  
  
  OBJECTIVE
  To conduct a review of medication information and identify prescribing error among an adult population in an urban hospital.
  
  
  METHODS
  Retrospective review of medication information was conducted. Part 1: an audit of discharge prescriptions which assessed: legibility, compliance with legal requirements, therapeutic errors (strength, dose and frequency) and drug interactions. Part 2: A review of all sources of medication information (namely pre-admission medication list, drug Kardex, discharge prescription, discharge letter) for 15 inpatients to identify unintentional prescription discrepancies, defined as: "undocumented and/or unjustified medication alteration" throughout the hospital stay.
  
  
  RESULTS
  Part 1: of the 5910 prescribed items; 53 (0.9%) were deemed illegible. Of the controlled drug prescriptions 11.1% (n = 167) met all the legal requirements. Therapeutic errors occurred in 41% of prescriptions (n = 479) More than 1 in 5 patients (21.9%) received a prescription containing a drug interaction. Part 2: 175 discrepancies were identified across all sources of medication information; of which 78 were deemed unintentional. Of these: 10.2% (n = 8) occurred at the point of admission, whereby 76.9% (n = 60) occurred at the point of discharge.
  
  
  CONCLUSIONS
  The study identified the time of discharge as a point at which prescribing errors are likely to occur. This has implications for patient safety and provider work load in both primary and secondary care.
authors.affiliation: School of Pharmacy, University College Cork, Cork, Ireland.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Michaelson
authors.affiliation: Department of General Practice, University College Cork, Western Gateway Building, Cork, Ireland. elaine.walsh@ucc.ie.
authors.forename: E
authors.initials: E
authors.lastname: Walsh
authors.affiliation: Department of General Practice, University College Cork, Western Gateway Building, Cork, Ireland.
authors.forename: C P
authors.initials: CP
authors.lastname: Bradley
authors.affiliation: School of Pharmacy, Queens University Belfast, Belfast, UK.
authors.forename: P
authors.initials: P
authors.lastname: McCague
authors.affiliation: School of Pharmacy, University College Cork, Cork, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Owens
authors.affiliation: School of Pharmacy, University College Cork, Cork, Ireland.|Mercy University Hospital, Cork, Ireland.
authors.forename: L J
authors.initials: LJ
authors.lastname: Sahm
mesh_terms: D000368:Aged; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007494:Ireland; D008297:Male; D008508:Medication Errors / Q000639:trends*; D010351:Patient Discharge / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D012189:Retrospective Studies
keywords: Hospital discharge; Medication reconciliation; Prescribing error; Transitional care