Impact of pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical center.

Pharmacists play an important role in medication reconciliation and decreasing medication discrepancies during admission and discharge. This evaluation of 31 patients participating in pharmacist-led discharge medication reconciliation found that 68% of patients had at least one medication error at discharge. Three-quarters of these errors were deemed serious and commonly involved duplication errors or medication access barriers.