OBJECTIVES: Medication-related errors account for many deaths annually, and there is increasing evidence that these errors frequently occur upon hospital admission and discharge. A pharmacist-conducted pilot program was designed to provide medication reconciliation services to high-risk patients shortly after hospital discharge to decrease medication-related errors. The primary objective is to evaluate the impact of a post-discharge quality improvement medication reconciliation service. METHODS: An algorithm was developed to identify patients at high-risk for readmission following hospital discharge. High-risk patients were defined as any member recently discharged from the hospital who was: a) receiving a high alert medication (e.g., warfarin); and/or b) was hospitalized for at least one pre-specified condition (e.g., Diabetes Mellitus). Within 2-5 days of hospital discharge, the Concurrent Review Nurses from a local health plan identified the high risk patients using the algorithm and notified the pharmacist.  The pharmacist contacted the patients via phone to complete a medication reconciliation and clinical review with either the patient or their caregiver. RESULTS: The program lasted from July 2013 to October 2013. In total, 125 patients were identified as high-risk patients, 47 of whom completed a clinical consult with the pharmacist. The average age of the patients who participated in the service was 66. The use of high-risk meds included warfarin (21%), antiplatelets (34%), digoxin (13%), and insulin (28%). In total, 5 patients in this group (11%) were re-hospitalized within 30 days. CONCLUSIONS: In the future, this pilot program should be conducted on a larger scale and include patients who are followed for a longer period of time. Anecdotal evidence suggested that the service was useful, however a larger number of patients is needed to achieve sufficient power to detect a statistical difference.