Effectiveness of a pharmacist-led quality improvement program to reduce medication errors during hospital discharge

Main Article Content


Patient Discharge, Medication Reconciliation, Medication Errors, Prescriptions, Pharmacy Service, Hospital, Pharmacists, Quality Assurance, Health Care, Malaysia


Background: Patients requiring medications during discharge are at risk of discharge medication errors that potentially cause readmission due to medication-related events.

Objective: The objective of this study was to develop interventions to reduce percentage of patients with one or more medication errors during discharge.

Methods: A pharmacist-led quality improvement (QI) program over 6 months was conducted in medical wards at a tertiary public hospital. Percentage of patients discharge with one or more medication errors was reviewed in the pre-intervention and four main improvements were developed: increase the ratio of pharmacist to patient, prioritize discharge prescription order within office hours, complete discharge medication reconciliation by ward pharmacist, set up a Centralized Discharge Medication Pre-packing Unit. Percentage of patients with one or more medication errors in both pre- and post-intervention phase were monitored using process control chart.

Results: With the implementation of the QI program, the percentage of patients with one or more medication errors during discharge that were corrected by pharmacists significantly increased from 77.6% to 95.9% (p<0.001). Percentage of patients with one or more clinically significant error was similar in both pre and post-QI with an average of 24.8%.

Conclusions: Increasing ratio of pharmacist to patient to complete discharge medication reconciliation during discharge significantly recorded a reduction in the percentage of patients with one or more medication errors.


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