Reducing Adverse Prescribing Discrepancies Following Hospital Discharge

Abstract

General medical patients from an east London teaching hospital were recruited into intervention and comparison groups. Those recruited into the intervention group were given a copy of a letter listing their drugs prescribed at discharge and asked to give it to their regular community pharmacist when they went to obtain their prescribed drugs following hospital discharge. A comparison group returned home without a letter for their community pharmacist. Recruited patients were visited in their own homes once their community supply of drugs had been obtained. The frequency of all discrepancies between the prescribed drugs were compared for both groups. A consensus panel judged the importance of the discrepancies observed. The numbers deemed as clinically significant were compared for both groups, as the effect of the intervention. The 501 patients followed up (264 in the intervention group and 237 in the comparison group) were prescribed 2,736 drugs. The number of unintentional discrepancies observed was lower for the intervention group (32.2 per cent, 454/1,408) than for the comparison group (52.7 per cent, 700/1,328) (chi-squared 117.38, P<0.001). The number of discrepancies judged to have a definite adverse effect was lower in the intervention group (1.6 per cent, 23/1,408) than in the comparison group (3.1 per cent, 41/1,328) (chi-squared 6.32, P<0.01). Discharging 19 patients with such information to take to their community pharmacist would result in the prevention of one unintentional discrepancy having a definite adverse effect. Providing community pharmacists with a copy of patients' discharge summaries is an effective method of reducing unintentional discrepancies, with measurable patient benefit.