Abstract

Aim: To establish the nature and frequency of discrepancies identified by pharmacy staff during medicines reconciliation.(MR)

Methods: Pharmacy staff collected data prospectively from 161 patients over a 1 week period, including information on any prescription errors identified.

Results: In total, 62 patients (48%) taking one or more medications prior to admission to hospital had one or more discrepancies found by pharmacy staff during MR. The most common discrepancy was omission of one or more drugs.

Conclusions: Pharmacy staff identified several unintentional discrepancies in prescribing of medications at admission to hospital. Doctors should ensure that intentional changes to patient prescriptions are clearly documented.
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