Medication reconciliation is considered complete, when each medicine that a person is taking has been actively continued, discontinued, held or modified at each point of transfer, and these details have been communicated to the next care provider. Local practice research had demonstrated that 50% of discharge prescriptions were non-reconciled. The aim of this project was to improve medication safety at the point of hospital discharge by using targeted medication reconciliation between the doctor and the pharmacist and producing a computer- generated prescription. The Health Service Executive Change Model was utilised as a change framework. The project was supported by a literature review and detailed analysis of the pre project status. Evaluation was performed using Stufflebeam’s Context, Input, Process, Product (CIPP) model. A pre and post change audit was performed against the HIQA National Standard for Patient Discharge Summary Information 2013. The overall compliance with the HIQA standards increased from 50.4% to 96.9%. The biggest change in percentage compliance was observed in the three communication categories, which explain to community healthcare providers the rationale behind the medication changes made during the hospital stay. Further refinement of the IT program and the targeting of patients are required for the next stage of the project. The change in practice improved the accuracy of the discharge prescriptions and the evaluation will be used to produce a business case to support the ongoing development of the project. This approach may be transferrable to other hospitals.
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