Table 3. Medication errors identified and pharmacist interventions.
| Intervention (n = 186) | n (%) |
| Medication reconciliation (n = 103) | |
| Incorrect dose or frequency | 49 (48) |
| Medication omitted | 33 (32) |
| Medication added | 14 (14) |
| Duplicate therapy | 4 (4) |
| Counseled on nonadherence | 3 (3) |
| Errors per patienta, mean | 2.4 |
| Therapeutic recommendations (n = 38) | |
| Route change | 29 (76) |
| Optimize therapy | 7 (18) |
| De-escalate therapy | 2 (5) |
| Discharge counseling (n = 45) | |
| Counseled on antibioticsb | 33 (73) |
| Counseled on chronic medication changes | 12 (27) |
Note: All data are given as n (%) unless specified otherwise, and all percentages were rounded to the nearest whole number.
a
n = 43 patients.
b
n = 39 patients were prescribed discharge antibiotics.