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Research Article Open Access
Objective: Medication reconciliation is the process of collecting a list of a patient’s medications including name, dosage, frequency, and route of administration. Medication reconciliation is important to reduce the risk of drug-related problems and is a National Patient Safety Goal. The objective of this study was to evaluate a pharmacist-performed medication reconciliation process to identify the pharmacist’s contribution in identifying high-risk patients, identifying medication-related problems (MRPs) and potential adverse drug events, and recommending alternative treatments to prevent MRPs.
Methods: This study was a cross-sectional analysis in an ambulatorycare clinic. Patients included in the analysis were taking at least 7 medications with at least 2 disease states, and had an appointment with a clinic provider from July to September 2013. The primary outcome was the number and type of MRPs encountered during pharmacist-performed medication reconciliations. We also identified patient factors associated with MRPs and provider acceptance of recommendations.
Results: Fifty-three patient visits were analysed. On average, 8 MRPs were found per visit. Patients saw an average of 8 providers in the 15 months preceding their visit. A total of 477 MRPs were addressed by the pharmacist, including 309 medication errors and 22 adverse drug events. The most common MRPs included the patient taking medications not on provider’s list (26%), discontinued medication on medication record (21.7%), and no monitoring for disease state or medication (12.8%). A statistically significant increase in the number of MRPs was found in patients taking greater than 10 medications (5 vs 9; p = 0.044) and those who saw at least 7 providers (7 vs 10; p = 0.02). Providers approved 74% of pharmacist recommendations.
Conclusions: Pharmacist-performed medication reconciliations resulted in a significant number of MRPs being identified and resolved.
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Author(s): Macheala Jacquez, Krystal Moorman*, Carrie McAdam-Marx, David Owen, Marisa B Schauerhamer and Brandon T. Jennings
Medication Reconciliation, Medication Errors, Community Pharmacy Services, Clinical Pharmacy, Patient care