Decreasing medication discrepancies between outpatient and inpatient care through the use of computerized pharmacy data.

CONTEXT The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) instituted a new regulation in 2006 to improve patient safety by decreasing medication errors. This requires a process for obtaining and documenting a complete list of each patient's current medications at hospital admission and communicating this list to the next clinician ("Medication Reconciliation"). OBJECTIVE We sought to determine whether medication discrepancies between outpatient and inpatient care can be decreased through the use of computerized pharmacy data. METHOD We evaluated outpatient medication prescriptions in 2000 and 2004 using computer-generated data for patients admitted from an Emergency Department to a medical ward. The hospital records and pharmacy data were reviewed to determine which ambulatory medications were ordered at admission, continued as an out-patient, and refilled three months after discharge. In 2004 additional computerized pharmacy data were provided to attending physicians. Ambulatory care "essential prescription medication groups" (cardiac, chronic obstructive pulmonary disease, asthma, diabetes, and neurologic) were also evaluated. Medication discrepancies for the years 2000 and 2004 were compared in several categories. RESULTS Medication discrepancies were found in all evaluated categories in 2000. The follow-up study showed a decrease in discrepancies for nearly all categories. CONCLUSION RESULTS show that use of outpatient pharmacy data can decrease medication discrepancies in compliance with current JCAHO requirements.