Prevent Medication Errors Research Articles

Evaluasi dan Pengembangan Model Sistem Informasi Manajemen Skrining Resep di Instalasi Farmasi RSUD Dr. Hasri Ainun Habibie Gorontalo dengan Metode EUCS

Introduction: Management information systems (SIMs) can provide data and information that can help facilitate prescription screening such as administrative, pharmaceutical, and clinical data. Data and information from the hospital management information system (SIMRS) are also to make it easier to screen prescriptions and prevent medication errors. Objective: This study aims to evaluate the need for a screening management information system at dr. Hasri Ainun Habibie Gorontalo and developed. As well as seeing the level of user satisfaction after the development of a prescription screening management information system Methods: The research conducted is quantitative descriptive. The data collection of system needs analysis was carried out by looking directly at the system at dr. Hasri Ainun Habibie Gorontalo Hospital. As well as evaluating the system using the End User Computing Satisfaction (EUCS) method by distributing questionnaires to pharmaceutical officers. After obtaining an analysis of the system needs, the design of the prescription screening management system was made using context diagrams, data flow diagrams (DFD), and entity relationship data (ERD). Data analysis to see the increase in satisfaction using the wilcoxon signed rank test. Results: The results of the observation of the completeness of prescription screening in the system at dr. Hasri Ainun Habibie Gorontalo Hospital show that administrative, pharmaceutical and clinical screening has not been fully completed. Meanwhile, the pretest results of the evaluation of the system that has been implemented in the hospital show that the frequency of respondents' answers in the dissatisfaction scale category in variable content is 97.2% and accuracy is 55.6%. However, after system development and re-evaluation as a result of the posttest, the results were obtained that the suitability of administrative, pharmaceutical and clinical screening on the satisfactory scale in variable content was 58.3%, format 51.9%, ease of use 66.7%, timeliness 55.8%, and very satisfied scale at variable accuracy 55.6%. Analysis of pretest and posttest data using the Wilcoxon test showed a significant value (p) of 0.007. Conclusion: The results of the evaluation and design of the prescription screening management information system have met the criteria and received increased satisfaction from system users. So that the system is ready to be implemented at dr. Hasri Ainun Habibie Gorontalo Hospital.

A Comprehensive Analysis of Medication Errors on Antimicrobials in a Tertiary Care Hospital of Northern India

Background: Medication errors, resulting from incomplete understanding, pose significant risks to patient safety. Antimicrobial medication error is a global concern further exacerbated by underreporting. This study aims to determine the prevalence of antimicrobial medication errors at a tertiary care medical facility. Methodology: A retrospective study was conducted over six months. Antimicrobial medication errors were analyzed and categorized as prescription, transcription, indenting, dispensing, and administration errors. A total of 208 antimicrobial medication errors were analyzed using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) risk index. Results: Among 6,439 medication charts assessed, 558 (9%) medication errors were identified, with antimicrobial errors accounting for 208 (37.2%). Prescription errors were the most prevalent (61%), followed by transcription errors (16%) and administration errors (11%). Dispensing, indenting, and documentation errors occurred at rates of 8%, 2%, and 2%, respectively. The primary causes of errors were incorrect doses (47.2%) and frequencies (30%). Approximately 55.3% of antimicrobial medication errors were classified as Category C according to the NCCMERP risk assessment. Conclusion: Prescription errors represent the majority of antimicrobial medication errors, underscoring the need for enhanced vigilance among consultant physicians during prescription writing and drug schedule checks.

Impact of pharmacist‐led discharge medication reconciliation on error and patient harm prevention at a large academic medical center

AbstractIntroductionMedication errors during hospital discharge can lead to adverse outcomes, medication‐related readmissions, and increased health care costs. Pharmacist‐led medication reconciliation at discharge is a potential solution to mitigate poor outcomes and optimize medication safety.ObjectivesThis study aimed to quantify medication errors identified at discharge and characterize the severity of patient harm prevented following pharmacist‐led discharge medication reconciliation. Cost avoidance analysis was conducted to determine its associated financial impact.MethodsPatients, who were discharged from an adult internal medicine service during October 2022, were included in this one‐month pilot prospective quality improvement study. The number of errors at discharge were documented, categorized by type, and adjudicated for severity of potential harm. Error severity was classified based on a modified National Coordinating Council for Medication Error Reporting and Prevention Medication Error Index. Cost avoidance was calculated based on whether each error would have resulted in additional medical encounters and length of stay.ResultsThirty‐one patients were included in the analysis. Forty errors were identified by pharmacist‐led medication reconciliation at discharge, with a mean of 1.3 ± 1.9 errors per patient and 68% of patients having at least one error. The most common errors were duplication of therapy (25%) and medication access barriers at discharge (25%). The severity of errors included low (22.5%), serious (75%), and life‐threatening harm (2.5%). Thirty‐five percent of errors could have led to emergency visits or hospital readmissions. The estimated total cost for errors was $25 600. Pharmacist labor cost for reconciliation was $816. Cost avoidance was $24 784 from the 14 errors at discharge that could have resulted in additional emergency or inpatient visits.ConclusionPharmacist‐led medication reconciliation at discharge may prevent harm from reaching patients, decrease cost from unnecessary health encounters, and stop the error from continuing across transitions of care.

Keeping patients safe through medication review and management in the community.

There are numerous publications on inpatient medication errors. However, little focus is given to medication errors that occur at home. To describe and analyse the types of medication errors among community-dwelling patients following their discharge from an acute care hospital in Singapore. This is a retrospective review of a 'good catch' reporting system from December 2018 to March 2022. Medication-related errors were extracted and analysed. A total of 73 reported medication-related error incidents were reviewed. The mean age of the patients was 78 years old (SD=9). Most patients managed their medications independently at home (45.2%, n=33). The majority of medications involved were cardiovascular medications (51.5%, n=50). Incorrect dosing (41.1%, n=39) was the most common medication error reported. Poor understanding of medication usage (35.6%, n=26) and lack of awareness of medication changes after discharge (24.7%, n=18) were the primary causes of the errors. This study's findings provide valuable insights into reducing medication errors at home. More attention must be given to post-discharge care, especially to preventable medication errors. Medication administration and management education can be emphasised using teach-back methods.

The prevention of medication errors in the home care setting: a scoping review.

The changes in health, social and demographic needs impose new approaches to cures and care without giving up patients' safety. Although several studies analysed the patient safety approach and strategies, the literature considering the home care setting seems still scarce. The analysis of the phenomenon of medication errors in the primary care setting highlights the necessity of exploring the specific variables to understand how to prevent or reduce the occurrence of a medication error in the home context. This review investigates the main preventive strategies implemented at the patients' home to prevent and/or limit the possibility of a medication error. The scoping review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses ex-tension for Scoping Reviews (PRISMA-ScR) statement and based on the guidelines of the Joanna Briggs Institute. No time or language limit was set to obtain the most comprehensive results possible. The following databases were queried: PubMed, Cochrane, CINAHL, ERIC and PsycINFO via EBSCO. All literature published up to 31 December 2022 was considered for data collection. The main preventive strategies implemented in the patient's home to prevent a medication error are: Multidisciplinary teams, therapeutic reconciliation and computerised systems that improve information sharing. As evidenced by all of the included studies, no educational intervention or preventive strategy individually reduces the risk of making a medication error. It would be desirable for healthcare professionals to be constantly updated about their knowledge and understand the importance of introducing the aforementioned preventive strategies to guarantee safe care that protects the person from me-dication errors even at the patient's home.

Medication Error Prevention Using Healthcare Failure Mode And Effect Analysis At Clinical Pharmacy Installation

Medication error is the second most common patient safety incident worldwide. Medication errors can be defined as unintentional failures in medication services that have the potential to cause harm to patients. Maintaining safe health services is highly dependent on the ability of service providers to proactively conduct patient safety risk analysis, one of which is using the Healthcare Failure Mode and Effect Analysis (HFMEA) method. This study was aimed at obtaining the HFMEA design as an effort to prevent medication errors at Company X Clinical Pharmacy Installation. The research method used is qualitative research with a specific type of Operations Research. Data collected by in-depth interviews, observation, secondary data analysis, and focus group discussion. The results of this study found factors that cause medication errors to occur from organizational factors and staff factors. These results then analyzed for the HFMEA design which obtained 11 risks that required attention and then 14 action plans are made to overcome them. This study successfully developed HFMEA design to prevent medication error in Company X Clinical Pharmacy Installation.

Patient safety culture and medication safety in European intensive care units: a focus group study

BackgroundPatients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its...

Medication errors at a diabetes management center in a resource-poor setting.

Medication errors are known to cause adverse drug reactions, hospital admissions and mortality. In most resource-poor settings, medication errors occur but are undocumented. This study sought to investigate medication errors in a diabetic clinic at Komfo Anokye Teaching Hospital (KATH), Ghana. The research combined both qualitative and quantitative data collection methods. The quantitative aspect involved retrospectively reviewing patient folders over two years (1st January 2019 to 31st December 2021). Patients' folders were reviewed to identify possible medication errors. The qualitative arm explored underlying factors and experiences related to medication errors through interviews with healthcare workers. Ten healthcare professionals at KATH were interviewed using an interview guide. A total of 264 patients' folders were retrieved. The majority (23.11%) of the patients were between 18 and 25 y.o., and there were more females (52.27%) than males. About 60% of the patients had diabetes and hypertension comorbidity. The overall prevalence of medication errors was 18.18%. The most prevalent type of medication error identified was wrong drug formulation (n = 19, 39.58%). About 47.92% of the medication errors resulted in adverse events and this was predominantly caused by antidiabetic drugs (47.83%) and anti-hypertensive drugs (34.78%). Patients in the age category of 26-35 y.o. [aOR: 0.31, CI: 0.11-0.90] had reduced odds of medication errors whilst patients with comorbidity of diabetes and hypertension [aOR: 5.95, CI: 2.43-14.60] had an increased odds of medication errors. Large patient population, low staff numbers and inadequate knowledge of drugs by healthcare workers were factors that contributed to medication errors. Medication errors was moderately high in this diabetic clinic, and the errors led to a number of adverse events. Age, diabetes and hypertension comorbidity, large patient population, low staff numbers, and inadequate knowledge about drugs were identified as factors that influenced medication errors.

Detection of Adverse Events With the Austrian Inpatient Quality Indicators.

Indicators based on routine data are considered a readily available and cost-effective method for assessing health care quality and safety. The Austrian Inpatient Quality Indicators (A-IQI) have been introduced in all Austrian public hospitals as a mandatory quality measurement. The purpose of this study was to assess the value of conspicuous A-IQI in predicting the presence of adverse events (AEs). We conducted an exploratory study comparing all indicator-positive patient cases contributing to 18 conspicuous A-IQI indicators to randomly selected indicator-negative control cases regarding the prevalence and severity of AEs. Structured medical record review using the Institute for Healthcare Improvement Global Trigger Tool was used as the gold standard. In 421 chart reviews, we identified 158 AEs. 70.9% (n = 112) of the AEs were found in cases with a positive indicator. The relative risk of an AE occurring was 3.47 (95% confidence interval: 2.30, 5.24) in indicator-positive cases compared to indicator-negatives. The proportion of severe events (National Coordination Council for Medication Error Reporting and Prevention Index categories H and I) was 54.5% (n = 61) in indicator-positive cases and only 15.3% (n = 7) in indicator-negative cases. Overall sensitivity of the A-IQI was 68.2%, specificity 69.4%, positive predictive value 36.0%, and negative predictive value 89.6%. Our study shows that significantly more AEs and more severe AEs were found in cases with positive A-IQI than in indicator-negative control cases. However, studies with larger numbers of cases and with larger numbers of conspicuous indicators are needed for the validation of the entire A-IQI indicator set.

Prevalence of Medications Errors and Factors of Harmful Errors in Neonates and Paediatrics at Tertiary and Paediatric Hospitals: A Multicenter Study

Medication errors (ME) are human mistakes that may occur during drug use, prescribing administration or monitoring. This study aimed to determine the Prevalence of MEs among pediatric patients receiving tertiary treatment in pediatric speciality hospitals and describe their patterns and causes. Three institutions participated in a multicenter retrospective analysis. Reports of all MEs involving paediatrics aged ≤13 years who were hospitalised or visited the Emergency Department or outpatient clinics were reviewed 1 January 2019 - 31 December 2019. The National Coordinating Council for Medication Error Reporting and Prevention classification was used to categorise MEs and to define PRME (category CI) and patient–harming MEs (category EI). A retrospective study was conducted with a total of 318 MEs reported, with an overall prevalence of 0.9 per 1,000 patients. The Prevalence was markedly lower in the CHT (0.35 / 1,000 patients) than in KAMC and KFSH&RC (1.73 and 3.5). The highest rate of MEs was observed in admitted wards (14.69 / 1,000 patients). Most commonly, MEs occurred at the prescribing stage (81.1%), were caused by a physician (83.3%), and were discovered by the pharmacist (85.5%). Improper medication dosage (34.0%), frequency (14.2%), and duration (10.4%) were the three most common forms of MEs. Paediatric inpatient treatment has a significant frequency of MEs, accounting for 24% of hospitalisations. The ME may not get to the patient if independent double-check prescriptions, accurate medication reconciliation of new prescriptions against the previously prescribed, and improved medicine labelling and packaging techniques are used.

Handing Off Electronic Prescription Data From Prescribers to Community Pharmacies: A Qualitative Analysis of Pharmacy Staff Perspectives.

The aims of the study are to understand the process of how community pharmacies handle electronic prescriptions (e-prescriptions) and learn about different errors or potential errors encountered. Fifteen remote, semistructured interviews were conducted with community pharmacy staff. Interview analysis was done with two adapted Systems Engineering Initiative for Patient Safety methods to understand the workflow and an affinity wall, which led to key words that were tallied to understand the frequency of different issues. Data entry in community pharmacies is a process that varies based on the different software platforms receiving e-prescriptions. Data entry of a medication product is typically a human-reliant process matching an e-prescription with an equivalent medication product. Current automated safety supports focus on matching the dispensed medication to the medication chosen at data entry. Substitutions may be required for a variety of reasons, however, pharmacists' comfort and permissions in doing so without provider involvement fluctuates. Prescription errors remain that could be prevented with additional support at the data entry step of e-prescriptions. Few studies demonstrate where these errors originate and what role current technology plays in contributing to or preventing these errors. Future work must consider how these matches between prescribed medications and pharmacy fulfilled medications occur. There is a need to identify potential tools to support data entry and prevent medication errors.

Analyzing override patterns in profiled automated dispensing cabinets at a tertiary care hospital in Saudi Arabia

BackgroundInappropriate automated dispensing cabinet (ADC) overrides pose a significant risk to patient safety. Bypassing pharmacist review during these overrides removes a vital safety check, leaving nurses to review complex medication orders alone. This can lead to overlooking incorrect orders and significantly increasing the potential for medication errors. While Institute for Safe Medication Practices (ISMP) guidelines promote profiled ADCs and safe override practices, there is no national standard for acceptable override rates. ObjectivesAssessing the appropriateness of ADC overrides of profiled ADCs at a tertiary hospital in Saudi Arabia in accordance with ISMP guidelines (third core safety process). MethodsThis retrospective observational study reviewed all override transactions for 13 profiled ADCs over a 3-month period, from 1 October 2022 until 31 December 2022. The target override rate was set at no more than 5%. After applying exclusions, the relevant data fields were extracted from electronic records of 2 integrated systems: the Omnicell dashboard and the BESTCare hospital information system. The study assessed whether the override transactions complying with the standard elements required for appropriate ADC overrides in accordance with ISMP recommendations and hospital regulations. ResultsSix hundred sixty-four override transactions from profiled ADCs were reviewed and evaluated. Although the overall override limit for profiled ADCs was met (1.9%), multiple inappropriate override practices were revealed. These inappropriate practices are missing physician orders (33.7%), undocumented verbal orders (31.5%), nonurgent physician orders (11%), missing (8.4%) or delayed (33.7%) administration records, and unrecognized override errors (5.3%). Only 3 (0.5%) met all the standard elements required for ADC overrides. ConclusionThe target override threshold of 5% is inadequate to demonstrate sufficient adherence to the standard elements of appropriate overrides or effectively prevent medication errors. Consequently, a significantly lower target threshold override limit, well below 5%, should be considered, especially with 24-hour pharmacy services and fully integrated computerized physician order entry with ADC system. A multidisciplinary override surveillance team is considered essential.

DETERMINATION OF NURSING INTERVENTIONS FOR PREVENTION OF MEDICATION ADMINISTRATION ERRORS

Purpose: This research was a descriptive study performed with the aim of determining nursing practices about preventing medication administration errors. Methods: This research was completed in an education-research hospital and a private hospital located in a metropolitan city in Turkey. For collection of data, forms about descriptive characteristics, features related to medication administration errors of nurses, individual practices and institutional precautions about preventing medication errors were used. The research included 275 nurses actively administering medication. Analysis of data used percentages, mean, standard deviation, one-way ANOVA, Kruskal Wallis and correlation analysis tests. Results: As a result of the research, 87.2% of nurses stated they always checked the patient’s name, medication name, medication dose, and medication administration route, while 8% stated they very rarely researched the correct preparation form based on medication properties. Nurses with postgraduate education, choosing the profession themselves and satisfied with the profession were identified to perform more interventions about preventing medication errors (p

Medication Reconciliation

The Institute of Medicine (IOM) stated that preventable medication errors are the mostcommon type of errors in healthcare. It is of fundamental significance when building a safercare continuum, as it highlights the reason for continuous and more vigilant medicationreconciliation and required effort at all interfaces of care, including community. Without arobust medication reconciliation process, the potential for catastrophic outcomes remains aconstant concern. Prevention of medication errors is essential through strategies that are basedin evidence of medication reconciliation strategies on medication errors in community

THE ROLE OF PATIENT SAFETY EDUCATION AND TRAINING IN IMPROVING PATIENT SAFETY

Background Patient safety education and trainings are an important element to promote patient safety culture. The demands on this training for the safety of healthcare staffs and patients are crucial due to the occurrence of preventable medical errors. These review aims to study the types of patient safety education and training that are delivered for the different target audiences as well as identifying the results of the training. Methods This study presents narrative review on literature on patient safety education and training. Peer-reviewed journals and previously published papers were searched using keywords including "patient safety training," "improvement," "outcome," "health care," and "health services". Inclusion criteria for the article include the article written in English and published between 2013 and 2018. We used several journal databases including the Journal of Patient Safety, BMJ, PubMed, BMJ Quality & Safety and Google Scholar. Results Reviews were done based on previously published papers. The findings revealed that the patient safety education and training are mostly conducted to nursing and medical students as well as trainee and residents. Besides, it was also conducted for anesthesiologists and patients. Typically, mannequin-based demonstrations and trainings are provided for medical students and educators through the workshop for physicians and nurses. In addition, most of the important role in ensuring patient safety is mainly done by nurses followed by the anesthesiologist. Conclusion In regards to patient safety, each department has a specific role in ensuring patient safety culture in a clinical unit. Patient safety education and training must be provided for all levels because they may greatly influence the outcome especially on the attitudes and behavioural changes.

Partnered pharmacist medication charting and prescribing in Australian hospitals.

Medication charting and prescribing errors commonly occur at hospital admission and discharge. Pharmacist medication reconciliation, after medicines are ordered by a medical officer, can identify and resolve errors, but this often occurs after the errors have reached the patient. Partnered pharmacist medication charting and prescribing are interprofessional, collaborative models that are designed to prevent medication errors before they occur, by involving pharmacists directly in charting and prescribing processes. In the partnered charting model, a pharmacist and medical officer discuss the patient's current medical and medication-related problems and agree on a medication management plan. Agreed medicines are then charted by the pharmacist on the inpatient medication chart. A similar collaborative model can be used at other points in the patient journey, including at discharge. Studies conducted at multiple Australian health services, including rural and regional hospitals, have shown that partnered charting on admission, and partnered prescribing at discharge, significantly reduces the number of medication errors and shortens patients' length of stay in hospital. Junior medical officers report benefiting from enhanced interprofessional learning and reduced workload. Partnered pharmacist medication charting and prescribing models have the best prospect of success in environments with a strong culture of interprofessional collaboration and clinical governance, and a sufficiently resourced clinical pharmacist workforce.

Development of 3D printed tissue-mimicking materials: Combining fiber reinforcement and fluid content for improved surgical rehearsal

The prevalence of medical errors during surgical procedures has led to a higher emphasis on improving surgical outcomes, by improving surgical planning and training. Anatomical models have become valuable tools for pre-operative planning and current 3D printed models strive to better match real soft biological tissues. This study aimed to develop novel 3D printed material composites with controllable mechanical properties that mimic soft tissue. Concepts of microstructuring, fiber reinforcement and fluid infill in extrusion-based 3D printing are combined to design tunable materials towards target tissues of porcine muscle and liver. Material characterization was performed in triangular wave cyclic experiments under uniaxial tension with increasing displacements. Hereby, initial EI and final EII elastic moduli were evaluated. Further, the viscous response was characterized by the dissipated energy ratio UD and suture retention strength (SRS) was determined by single tensile pull-out tests Elastic moduli of printed materials were successfully tuned to 510 ± 10 kPa, closely resembling porcine muscle with 580 ± 150 kPa. The dissipated energy ratio UD of the silicone was increased from 0.09 ± 0.01 to 0.46 ± 0.17 by addition of gyroid infill and viscous fluid. Suture retention strength (SRS) for porcine liver tissue was 1.64 ± 0.42 N, while that of 3D printed silicone showed a mean SRS of 5.1 ± 0.6 N. Although the exact properties of porcine muscle and liver tissue require finer tuning, this study established techniques for refinement of 3D printed tissue-mimicking materials, ultimately enabling more accurate models for surgical rehearsal.

Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit.

Medication reconciliation errors are a common problem in health care, particularly during transitions of care. Discharge medication reconciliation (DMR) errors in a pediatric setting can range from 26% to 42.2%. We conducted a quality improvement project to decrease DMR error rate at Dayton Children's Hospital in Dayton, Ohio. We conducted 2 interventions, each with 3 Plan-Do-Study-Act cycles from September 2021 through February 2023. The first intervention focused on using current specialty neurology nurses as scribes and creating a template note to include the plan of care and review of DMR before discharge. Our second intervention consisted of standardizing the seizure rescue medication order by creating an order panel within our electronic medical record system for all the rescue medications presently available. Medication errors were documented by the specialty neurology nurse during a phone conversation on the next business day post discharge. DMR error rates were calculated for each week using a control chart. Medication errors and patient harm were classified according to the National Coordinating Council for Medication Error Reporting and Prevention Index. One hundred six errors were noted. Of these, 98 (92%) occurred in patients with seizure and 64 (60%) were related to prescription of seizure rescue medication specifically. The baseline error rate was calculated at 15.7% or 7 errors per month (January 2021 through June 2021). The average error rate dropped from 15.7% to 5.3% (2 errors per month) after initiation of our first intervention (September 2021). Twelve weeks after initiation of the second intervention, a 2.9% (1 error per month) was noted. Afterward, there was a ten-week period of 0% errors. Sustainable reduction of DMR errors in pediatric patients with epilepsy was achieved by using specialty neurology nurses to scribe the care plan and creating order panels to facilitate accuracy of discharge medication orders without additional cost to the hospital.

Barriers to medication error reporting in a federally qualified health center

ObjectiveTo explore the National Coordinating Council for Medication Error Reporting and Prevention Categories of Errors health professionals are most likely to report and characterize what barriers to medication error reporting influence decisions to report and the extent they do so at a large federally qualified health center (FQHC). DesignProspective, cross-sectional, survey. Setting and participantsA total of 161 medical professionals at a large FQHC clinic with a small pharmacy team. Outcome measuresSurvey responses to explore respondent understanding of medication error categories and the influence of barriers to medication error reporting on their decision to report. ResultsThirty-six (22.4%) respondents completed the survey. Nearly 40% of respondents would not report a near-miss error and were influenced by workplace/environmental barriers significantly more than those who would report. Regardless of reporting experience or patient-care role, assessed barrier categories influence the decision to report similarly. ConclusionNear-miss medication errors are inconsistently reported. Efforts to improve reporting should emphasize addressing workplace/environmental barriers.

Medication discrepancies across care transitions and the role of pharmacy technicians: A retrospective chart review

BackgroundAfter hospitalization, older adults are increasingly discharged to postacute care facilities such as skilled nursing facilities (SNFs). Medication reconciliation and obtaining the best possible medication history (BPMH) are key components of medication management for care transitions and essential for preventing medication errors and adverse drug events. ObjectiveThis study aimed to assess medication discrepancies across care transitions after a Certified Pharmacy Technician (CPhT) obtains the BPMH on hospital admission. MethodsSingle-center, retrospective chart review and included adults ≥ 18 years admitted to the medicine service and discharged to a SNF between November 2016 and June 2017. Medication lists were evaluated for discrepancies across 3 transitions: hospital admission to hospital discharge (Time I), hospital discharge to SNF admission (Time II), and SNF admission to SNF discharge (Time III). Discrepancies were categorized by medication class, type of discrepancy, and whether it was potentially intentional or unintentional. ResultsIn 127 patients, the average age was 83.3 (SD 9.16), 61% (n = 77) were female, and 67% (n = 85) were white. Median hospital length of stay (LOS) was 6 days (interquartile range [IQR] 4-10) and SNF LOS 21 days (IQR 15-30). Across 381 transitions, 6322 medications were reviewed, and 2602 discrepancies identified. The total number of medication discrepancies was 1034 (Time I), 687 (Time II), and 881 (Time III), respectively. All patients had at least one medication discrepancy. The average number of potentially unintentional discrepancies per patient at each transition was 0.14, 0.2, and 0.16, respectively. The most common discrepancy type was omissions (39%), and the highest number of discrepancies in the potentially intentional and unintentional discrepancy groups was gastrointestinal (21%) and cardiovascular medications (24%), respectively. ConclusionMedication discrepancies are common across all care transitions. Future studies are needed to evaluate the role of CPhT in obtaining the BPMH on hospital admission for reducing medication discrepancies across the continuum of care.