The aim of this study is to quantify prescribing errors relating to pre‐admission medication in patients admitted to hospital. It also assesses the impact of a hospital pharmacist in identifying and correcting these errors. Standard prescription monitoring by the pharmacist took place on admission in phase 1 (526 patients). This was compared with an extension of the pharmacist’s role in phase 2 (506 patients) by taking a detailed medication history, including assessment of patients’ own drugs (PODs). A significant increase (p < 0.001) in errors detected and corrected was identified. In phase 2, 45.1 per cent of prescription charts contained one or more errors. Of these errors, 74.8 per cent could not be identified from checking the drug chart alone. As this is the principal method by which many hospital pharmacists check patients’ medication charts this is an area of concern. More than 50 per cent of errors were considered likely to cause destabilisation of a chronic medical condition, or serious adverse events. It has been shown that an effective way to prevent these errors and ensure the continuity of medication between primary and secondary care is for pharmacists to take a detailed drug history on admission.

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