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

Ir J Med Sci. 2008 Jun;177(2):93-7. doi: 10.1007/s11845-008-0142-2. Epub 2008 Apr 15.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / drug therapy*
  • Continuity of Patient Care / standards
  • Continuity of Patient Care / statistics & numerical data*
  • Documentation / statistics & numerical data*
  • Drug Information Services / statistics & numerical data*
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Hospital Records / statistics & numerical data
  • Humans
  • Ireland
  • Male
  • Medical Staff, Hospital / standards
  • Medication Errors
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Process Assessment, Health Care