Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care

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. Aims  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.