Characterization of interventions to reduce the frequency of critical medication doses missed or delayed during perioperative and unit-to-unit patient transfers.

During care transitions, the medication administration record (MAR) is put on hold, which can result in missed or delayed medications. In this study, rates of missed or delayed critical medications (antibiotics, antifungals, antivirals, anti-seizure medications, and immunosuppressants) were compared before and after an intervention consisting of pharmacist alerts for patients with MAR holds in the previous 12 hours and/or 12 hours in the future. After implementation, overall rates of missed and delayed medications did not change, and rates of "multiple missed doses" decreased.