Evaluation of adverse drug events and medication discrepancies in transitions of care between hospital discharge and primary care follow-up.
Patients are particularly vulnerable following hospitalization, a period during which discharge communication, pending tests, and medication reconciliation are all known challenges. This study sought to evaluate medication safety after hospital discharge, a juncture commonly associated with adverse drug events. Pharmacists performed medication reconciliation and found discrepancies between the patient-reported medication regimen and electronic health record–generated information in the vast majority of cases. This gap between patient reports and hospital documentation emphasizes the ongoing challenge of safe medication use following hospitalization, despite longstanding awareness. A past AHRQ WebM&M commentary describes post-discharge medication problems.