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

Patients requiring medications during discharge are at risk of discharge medication errors that potentially cause readmission due to medication-related events. The objective of this study was to develop interventions to reduce percentage of patients with one or more medication errors during discharge. 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. 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