Discharge order verification process to reduce prescription errors and optimize diabetes management

Area of Science:

• Pharmacy Practice
• Medication Safety
• Diabetes Management

Background:

• Discharge prescription errors negatively impact patients, particularly those with diabetes mellitus (DM).
• A team-based, patient-centered approach can reduce medication errors and improve outcomes.
• An inpatient pharmacist-led initiative was implemented to verify antidiabetic prescriptions before electronic prescribing.

Purpose of the Study:

• To assess the effectiveness of pharmacist-led discharge order verification for antidiabetic medications.
• To improve the accuracy and appropriateness of prescriptions for DM patients before transmission to community pharmacies.

Main Methods:

• A 4-week proof-of-concept study involving adult DM patients with discharge orders.
• Orders were reviewed in the electronic health record (EHR) for safety, effectiveness, and accessibility.
• Pharmacist interventions were documented, and data on intervention types, acceptance, and outcomes were collected.

Main Results:

• 152 orders for 63 patients were verified; 60.3% required intervention.
• 56 interventions were made, including adding necessary drugs, clarifying instructions, and adjusting doses.
• 73.7% of patients were discharged on an optimized medication regimen.

Conclusions:

• A pharmacist-driven discharge order verification process effectively identifies and corrects errors in antidiabetic prescriptions.
• This model improves medication safety for DM patients at discharge.
• High provider acceptance and execution rates indicate the value of pharmacist interventions.