Irish Journal of Medical Science

, Volume 177, Issue 2, pp 93–97 | Cite as

Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care

  • T. GrimesEmail author
  • T. Delaney
  • C. Duggan
  • J. G. Kelly
  • I. M. Graham
Original Article



Medication discrepancies at the time of hospital discharge are common and can result in error, patient/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events.


To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital.


This was an observational study of 139 cardiology patients admitted over a 3 month period during which a pharmacist prospectively recorded details of medication inconsistencies.


A discrepancy in medication documentation at discharge occurred in 10.8% of medication orders, affecting 65.5% of patients. While patient harm was assessed, it was only felt necessary to contact three (2%) patients. The most common inconsistency was drug omission (20.9%).


Inaccuracy of medication information at hospital discharge is common and compromises quality of care.


“Continuity of patient care” Drug therapy Hospital communication systems Medication errors Patient discharge 



Completion of this study would not have been possible without the help of nursing, pharmacy, medical and administrative staff in the study hospital. The authors also wish to acknowledge the time and input of those involved in assessing the clinical importance of medication errors.


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Copyright information

© Royal Academy of Medicine in Ireland 2008

Authors and Affiliations

  • T. Grimes
    • 1
    • 2
    Email author
  • T. Delaney
    • 3
  • C. Duggan
    • 4
  • J. G. Kelly
    • 5
  • I. M. Graham
    • 3
  1. 1.School of PharmacyRoyal College of Surgeons in Ireland (RCSI)Dublin Ireland
  2. 2.The Adelaide and Meath Hospital, Incorporating the National Children’s Hospital (AMNCH)Dublin 24Ireland
  3. 3.AMNCHDublinIreland
  4. 4.School of PharmacyUniversity of LondonLondonEngland
  5. 5.RCSIDublinIreland

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