Decision Support Systems, Clinical 1 Hospitals 1 Humans 1 Medication Reconciliation 1 Patient Discharge 1 Retrospective Studies 1 adult 1 article 1 clinical decision support system 1 cohort analysis 1 decision support system 1 formulary stewardship 1 hospital 1 hospital discharge 1 human 1 incidence 1 medication error 1 medication reconciliation 1 medication therapy management 1 medication-use policy outcome assessment 1 pharmacy technology 1 prescription 1 retrospective study 1 therapeutic interchange 1 university hospital 1