The challenge of discharge: combining medication reconciliation and discharge planning

The appropriateness, safety and timeliness of individualised medication plans must be improved

The article by Tong and colleagues in this issue of the Journal1 describes a trial in which pharmacist-completed medication management plans in electronic discharge summaries were compared with standard medication management plans completed by medical officers. The pharmacist-completed medication plans were found to include significantly fewer potential errors, including high and extreme risk errors, than standard medication plans. The authors noted some limitations to their study. We also acknowledge general limitations in this area, specifically that transcribing errors have not been clearly correlated with adverse events, although they have potential to be so. This is perhaps because some transcribing “errors” are appropriate and intentional omissions from the discharge scripts, but this is not well communicated. Some potential errors may be both high and low risk errors, depending on the drug, patient and the clinical situation, and therefore only cause adverse events in some situations, which may have been factored in by the discharging team. The transcribing errors counted in the study by Tong and colleagues include omitted drugs, whether appropriate or not, and errors with the potential to cause an adverse event.