From hospital admission to discharge: An exploratory study to evaluate seamless care

Aim. To evaluate the effect of pharmaceutical care from admission, through a hospital stay and following discharge. Design. The study design was descriptive, using qualitative methods to compare intensive pharmaceutical care provision between a trial group and control group of patients. Subjects and Setting. General medical patients admitted to the medical admissions unit of a London Teaching Hospital were purposively sampled according to age, sex, and admitting diagnosis. Outcome measures. Discrepancies occuring in prescriptions for trial and control groups. The patients' ability to describe their drug treatment regimen before and after the intervention. Results. Of the 110 drugs observed on admission in the trial group, 85.5% were associated with a discrepancy, of which 60.0% were classified as unintentional. The intervention resulted in a reduction of unintentional drug discrepancies occuring at discharge. Within the trial group 11.8% of drugs were associated with unintentional discrepancies, significantly lower than 70.2% unintentional discrepancies on admission (X = 20.25, P