Clinical outcomes of a home-based medication reconciliation program after discharge from a skilled nursing facility.
Inadvertent medication discrepancies are common at the time of transitions in care, and medication reconciliation is being widely advocated as a method of preventing medication errors in this setting. This controlled trial used clinical pharmacists to identify and intervene on medication discrepancies after patients were discharged from skilled nursing facilities. Patients receiving the pharmacist intervention had significantly reduced mortality in follow-up, although the investigators were not able to confirm if this reduction was due to prevention of medication errors. Prior research in this area has also documented the value of clinical pharmacists in preventing medication errors during care transitions.