Clinical Pharmacist-Led Medication Reconciliation Initiative at a Newly Established Hospital in Qatar: A Preliminary Report

Hala Sonallah,Dalia Ahmed,Mohamed Izham Mohamed Ibrahim,Dalia Abdul Sattar,Tarek Ibrahim

doi:10.23937/2469-5823/1510083

Hala Sonallah, Dalia Ahmed + Show 3 more

Open Access

https://doi.org/10.23937/2469-5823/1510083

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Abstract

This preliminary study was conducted to identify the types and frequency of medication discrepancies, and clinical pharmacists' interventions made upon patients' admission. Medication Reconciliation (MR) was done by clinical pharmacists routinely on inpatients from intensive care unit, medical and surgical wards at Al Wakra hospital. This retrospective study was conducted on 251 MR forms used by the clinical pharmacists.

Highlights

Hospital admission is an interface of care when medication delivery becomes a complex process, and when more than half of medication errors occur [1,2] Discrepancies in medication history taking accounts for approximately 67% - 85% of these medication errors, with a potential harm range from 11% to 59% [3,4,5,6,7].Medication reconciliation is one of the best preventative strategies that has been proven to significantly reduce discrepancies and subsequent errors in relation to medication history, especially when conducted by clinical pharmacists [2,5]
Medication discrepancies upon hospital admission are highly common
In 2005, The Joint Commission on Accreditation of Healthcare (JCOAH) put forth medication reconciliation as National Patient Safety Goal (NPSG) in an effort to minimize adverse events caused during care transitions [5]

Summary

Introduction

Hospital admission is an interface of care when medication delivery becomes a complex process, and when more than half of medication errors occur [1,2] Discrepancies in medication history taking accounts for approximately 67% - 85% of these medication errors, with a potential harm range from 11% to 59% [3,4,5,6,7].Medication reconciliation is one of the best preventative strategies that has been proven to significantly reduce discrepancies and subsequent errors in relation to medication history, especially when conducted by clinical pharmacists [2,5]. As defined by the Joint Commission medication reconciliation is: “the process of comparing the medications a patient is taking (and should be taking) with newly ordered medications” in order to resolve discrepancies or potential problems [1]. Many international patient safety-leading organizations have been paying much attention to implement medication reconciliation in health care settings, such as Institute of Healthcare Improvement and Institute for Safe Medication Practices [5]. Both Joint Commission in the United Sates and Accreditation Canada have designated it as a required organi-

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