Abstract:
Aim: The aim of this study was to determine the impact of introducing a clinical pharmacist led discharge service on medication safety at the point of discharge and its acceptability to healthcare staff. Methods: A retrospective chart review to identify medication discrepancies was undertaken before and after the introduction of a pharmacist led discharge service. An evaluation was undertaken by means of a questionnaire to community pharmacists, GPs and hospital clinicians. Results: The pharmacist led discharge service significantly reduced errors from 50% (n=17) to 7% (n=2) of patients (p<0.001) and 10% (n=22) to 1% (n=2) of medication orders (p=0.001). The evaluation revealed that the majority of clinicians found the service useful, had the potential to reduce errors and improve communication. Conclusion: Pharmacist involvement at the point of discharge had a significant impact on medication safety. Crucially, in this project, we show the service was received well by medical personnel and improved communication between primary and secondary care, enhancing implementation potential.
