DISCHARGING PATIENTS WITH PRESCRIPTIONS INSTEAD OF MEDICATIONS - SEQUELAE IN A TEACHING HOSPITAL

Objective. This study measures the incidence of discrepancies among wr itten prescriptions, medication regimens transcribed onto patient disc harge instruction sheets (DCIs), and labels on medications dispensed b y community pharmacies after discharge of patients from an academic me dical center. Methods. During a 2-month study period, we collected cop ies of prescriptions and DCIs. We also called care givers after discha rge and asked them to read the medication labels that were filled from discharge prescriptions. Care givers were also asked whether they rec eived instruction from community pharmacists. Results. Data were colle cted on 335 prescriptions for 192 patients. Differences among the pres criptions, DCIs, and medication labels were found for 40 (12%) of the medications prescribed at discharge, representing 19% of the patients studied. Nineteen prescriptions had prescriber errors in dosing freque ncies or dosage formulations. Three prescriptions were filled with dif ferent medication concentrations or strengths than requested. Prescrip tions were altered by the community pharmacists for unexplained reason s in 6 cases, whereas the DCIs and original prescriptions differed in 12 cases. Only 44% of families were counseled about proper medication administration by their pharmacists. Conclusions. A potential for medi cation errors exists when pediatric patients are discharged with unfil led prescriptions. The potential may be worsened when discharge instru ctions are created from a prescription rather than from the label of a dispensed medication. Educational and risk-management efforts should emphasize the importance of writing complete, legible prescriptions an d consulting appropriate reference materials to ensure that dose formu lations and guidelines are accurate. Whenever possible, prescriptions should be filled before patients are discharged, so that the dispensed medications can be reviewed, and health care providers can provide ac curate discharge instructions.