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CP-051 An audit to determine the impact of pharmacist medication reconciliation on discharge (MROD) within a tertiary cardiac centre
  1. S Fhadil,
  2. P Wright,
  3. S Antoniou
  1. Barts and the London NHS Trust, Pharmacy, London, UK


Background Waiting for medication at discharge is often quoted as a key factor for delaying patients leaving hospital1. The rate limiting step in provision of medication at discharge is preparation of a medication list, from which pharmacy provide a supply. Preparation of a discharge summary (TTA) is completed and validated by junior medical staff after completing clinical tasks that delay the final act of supplying discharge medication.

Purpose To determine whether accredited pharmacists improve timing and accuracy of discharge by reconciling TTA medication.

  • 100% of TTAs reconciled by pharmacists will contain no discrepancies.

  • 70% of discharge prescriptions written at least a day in advance of a patient’s discharge.

  • 70% of discharge prescriptions not changed after dispensing completed.

Material and methods Baseline data were collected prospectively for 2 weeks in July 2015 on one cardiothoracic ward prior to implementation of the MROD policy. The audit was repeated over a 2 week period in September 2015 whereby an accredited pharmacist reconciled discharge medication for medics to determine safety and efficacy. Ethics approval was not required.

Results Results of TTA discrepancies and relevant timings have been collated and displayed in table 1.

Abstract CP-051 Table 1

Clinical impact of pharmacist reconciling TTAs

Conclusion MROD by pharmacists led to a significant reduction in discrepancies compared with baseline. The majority of TTAs (72%) were unaltered after completion and most (72%) written at least 24 h prior to discharge, suggesting pharmacy led MROD is both safer and more effective than conventional discharge process.

References and/or Acknowledgements

  1. Gross, Z. How pharmacists help speed up the discharge process to release beds. Pharm J, 2001. Available at (accessed 06/09/15)

References and/or AcknowledgementsNo conflict of interest.

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