A randomised, controlled trial of a pharmaceutical discharge service

Objectives: Identification of drug related problems associated with the traditional system of hospital patient discharge. Development and evaluation of a pharmaceutical discharge service with respect to medication errors, patients' and doctors' views, and some associated costs and savings. Methods: Development of the service was followed by a controlled trial. Seventy patients recruited from medical wards were randomly allocated to intervention (pharmaceutical discharge service with a pharmacist undertaking a supplementary drug history, reissuing appropriate medication, discharge counselling and preparing a typed discharge medicines letter for the GP), or control groups (traditional system of doctor-acquired drug history and doctor handwritten information on discharge medication to GP). Domiciliary visits were undertaken three weeks after discharge and the prevalence and severity of medication errors and the prevalence of intentional changes to medication by doctors was determined. Patients' and general practitioners' opinions' of the provision of discharge medicines related information was sought and the costs and savings associated with the service were estimated. Results: The pharmaceutical discharge service significantly reduced the number of patients experiencing medication errors from 55% to 11% (p=0.001, chi square test), but did not alter the mean severity of medication errors (p=0.45, Mann-Whitney test), or the prevalence of intentional changes to medication made by doctors after patients were discharged, which occurred in 24% of intervention and 36[percent] of control patients. Fewer intervention group patients reported problems with medication after discharge (p=0.001, chi square test), or having outstanding questions regarding discharge medication (p=0.01, chi square test). Hospital savings of £97.05 were realised by reissuing 80% of suitable medication. Conclusion: A comprehensive pharmaceutical discharge service can reduce errors after discharge. Medication changes occur in medical patients after discharge and may be appropriate. The savings from reissuing drugs may not recoup the cost of providing the service