This prospective clinical evaluation was conducted in the intensive care unit (AICU)/ high dependency wards of a large NHS teaching hospital. Adult patients who were admitted to adult intensive care unit (AICU), medical high dependency and surgical high dependency wards during a 5 week period in February and March 2014 with at least four regular prescribed medications and had their
medication history checked by a pharmacist were included in the study. Patients included were followed from the date of admission mTOR inhibitor to the date of discharge. Information on discharge procedures from critical care to primary care was not collected as it was outside the scope of this research project. Patients who remained hospitalised or died were excluded from the analysis. No ethical approval was necessary. Of the 65 patients who were followed during study period, 9 (13.8%) patients died and 17 (26.1%) patients remained hospitalised at the end of the study period, 3 (4.6%) patients had no discharge summary record, 4 (6.2%) patients were transferred to another hospital, hence the remaining 32
(49.2%) patients formed the study group for analysis. In total, 267 pre admission prescription items were recorded for the study group, the majority of selleck chemicals llc the items were gastrointestinal (GI) (n = 62, 23.2%), cardiovascular (CV) (n = 71, 26.6%), and central nervous system (CNS) (n = 56, L-gulonolactone oxidase 21.0%) drugs. Of the 267 items recorded, 23 (8.6%) had missing information on dose or frequency and 5 (1.9%) items having dose and frequency information omitted. Of the 307 discharge items were prescribed for the study group. 191 (62.2%) items where altered from the preadmission medication list of the study group, comprising of the addition of new medication (n = 125, 65.4%), and discontinued pre admission
medication (n = 66, 34.6%). Of these altered medication, a total of 83 medication items were changed without reason given; including 47 (56.6%) items discontinued and 36 (43.4%) items newly prescribed at discharge. The rate of alteration of pre admission prescription at discharge was very high 62.2%. A high proportion of the altered prescribed discharge medication did not have reasons for changes made 43.5 %. (i.e. stop information for pre admission medication and start information for new drugs). This high proportion of changes to patient medication history at discharge without complete information could lead to un wanted adverse drug events. Reasons for these omissions should be determined in order to ensure that upon discharge, patients complete patient medication information is sent to primary care. 1. Wong J.D, Bajcar J. M, Wong G.G, Alibhai S, Huh J.H, Cesta A, Pond G.R, Fernandes O.A. Medication reconciliation at hospital discharge: Evaluating discrepancies. Ann pharmacother 2008; 42:1373–1379. K. Marsdena, N. Salemaa, R. Knoxa, G. Gookeyb, M. Bassic, T.