Pharmacist Discharge Medication Reconciliation Study

The Impact of Pharmacist Discharge Medication Reconciliation on Unintentional Medication Discrepancies From Inpatient Discharges at the Alberta Cancer Board Cross Cancer Institute

Adverse drug events can occur commonly due to medication errors during the transition of care in a health care facility. Medication reconciliation is the process of comparing medications and providing an accurate medication list as a resource for prescribers, which is currently only being done upon inpatient admission at the CCI. The purpose of this study is to see if pharmacist medication reconciliation at discharge reduces unintentional medication discrepancies for inpatient discharges.

Inclusion Criteria:

• Cancer inpatients under the care of Dr. Follett or Dr. Candler
• Cancer inpatients to be discharged from the CCI
• Patients >18 years of age
• Patients that are taking >1 medications or herbals total at home.

Exclusion Criteria:

• Cancer inpatients that are considered radioactive or in "hot rooms" (ie. Selectron patients or patients receiving radiation treatment for thyroid)
• Patients that do not remain in hospital >72 hours
• Patients without a home phone number or equivalent contact number.
• Language barrier (patients unable to speak or understand English).
• Patients that are readmitted and already included into the study.