Medication Reconciliation Process Research Articles

New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19.

Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored. To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge. Single center retrospective cohort study. Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof. None. Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge. One thousand three hundred and nineteen patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42-4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.

Medication Reconciliation

The Institute of Medicine (IOM) stated that preventable medication errors are the mostcommon type of errors in healthcare. It is of fundamental significance when building a safercare continuum, as it highlights the reason for continuous and more vigilant medicationreconciliation and required effort at all interfaces of care, including community. Without arobust medication reconciliation process, the potential for catastrophic outcomes remains aconstant concern. Prevention of medication errors is essential through strategies that are basedin evidence of medication reconciliation strategies on medication errors in community

Medication discrepancies identified by medication reconciliation among patients with acute coronary syndrome.

Medication errors such as medication discrepancies are known as one of the leading cause of death. Medication discrepancies mostly occur during admission and at time transfer of care and discharge. Medication reconciliation process has pivotal role to avert medication discrepancies and improve patient safety and quality. Patients with acute coronary syndrome (ACS) are prone to medication discrepancies due to acute manifestations, simultaneous use of different medicines and having different co-morbidities. This study aimed to determine medication discrepancies identified by medication reconciliation among patients with ACS.In an observational study, patients with ACS admitted to a specialized Hospital in Baneh County, Kurdistan province during September 2023 and January 2024 were included. Medication reconciliation process was done when the patient was admitted. The history of medicine use was collected through interviews with the patient, their caregivers, as well as observing the medicines that were accompany with the patients. Number and type of unintentional medication discrepancies and related factors were evaluated.A total of 280 ACS patients (mean age: 63.8 ± 14.2, male gender: 59.3%) were included in the study. About 68% had at least 2 underlying diseases. The mean daily medicines taken by the patients during admission were 8.5 ± 1.54. The number (percentage) of unintentional inconsistency was observed in 78 (27.3%), and omission (39.7%) and changes in dosage (20.5%) had the highest frequency of unintentional medication discrepancies, respectively. Cardiovascular agents such as anti-dyslipidemia and antiplatelet had the highest frequency of unintentional medication discrepancies. The number of underlying diseases and daily medications before hospitalization increase the odds of discrepancies by 2.15 and 1.49 times, respectively (p-value < 0.05).Medication discrepancies identified by medication reconciliation among patients is relatively common. Unintentional medication discrepancies that have the potential to harm the ACS patients should be given more attention, especially in patients with multiple comorbidities and polypharmacy.

Understanding Trainee and Patient Behaviors to Enhance Medication Reconciliation Processes in the Outpatient Neurology Clinic: A Quality Improvement Initiative (P7-4.006)

Understanding Trainee and Patient Behaviors to Enhance Medication Reconciliation Processes in the Outpatient Neurology Clinic: A Quality Improvement Initiative (P7-4.006)

Development of a Discharge Counseling and Medication Reconciliation Process for Pediatric Patients Within a Large, Academic Health System

OBJECTIVE This study aims to characterize the impact of a pharmacist-driven discharge medication reconciliation and counseling program targeting high-risk pediatric patients to mitigate barriers in transitions of care. METHODS This was a single-center quality improvement initiative including high-risk pediatric patients within a large academic medical center. Pharmacy, medical, and information technology team members developed a scoring system to identify patients at high risk of hospital readmission that resulted in a trigger tool built within the electronic medical record (EMR). Pharmacy workflow, the EMR documentation, and staff training were implemented. The primary end point was the number of high-risk patients with complete medication reconciliation and/or discharge counseling performed during the first 2 months after implementation. The secondary end points included quantification and qualification of the interventions conducted by a pharmacist. RESULTS Pediatric clinical pharmacists conducted discharge medication reconciliation and/or counseling for 60 patients during the first 2 months after implementation. There were 65 interventions performed, including 60 discharge medication reconciliations and 5 discharge counseling sessions. Of these interventions, 22 were recommendations on appropriate medication dosing and frequency (37%), 12 on duration of therapy (20%), and 8 were medication additions (13%). There were 6 interventions on adherence assistance (10%), 6 involved selection of medication formulation (10%), 3 involved medication discontinuation (5%), 2 involved appropriate therapy selection (3%), and 1 involved medication stability (1%). All interventions were accepted and implemented by the prescribing providers. CONCLUSIONS Pharmacist-driven discharge medication reconciliation and counseling programs targeting pediatric high-risk population might be an effective tool to mitigate gaps in transitions of care.

Medication Reconciliation as Repair Work.

In Norway, the process of developing a national shared medication list has been underway for several years. The shared medication list provides an overview of all the medications used by a patient. However, its proper use requires that it be maintained regularly through so-called medication reconciliation processes in which health personnel clarify - and ask patients - what and how much medication they use. We explore the work embedded in the bedside medication reconciliation process at a hospital, the health personnel conducting this work and the implications for the shared medication list. We argue that reconciliation processes can be conceptualized as collective repair work that needs to be continued after the shared medication list is implemented.

Using Electronic Health Records and Linked Claims Data to Assess New Medication Use and Primary Nonadherence in Rheumatology Patients.

The objective of this study was to determine the proportion of new medication prescriptions observed in electronic health records (EHR) that represent true incident medication use, accounting for undocumented previous prescriptions (prevalent medication use) and failure to initiate treatment (primary nonadherence) with linked administrative claims data as the reference standard. Using single-specialty rheumatology EHR data from more than 700 community practices in the United States linked to administrative claims data, we identified first (index) EHR prescriptions and assessed the positive predictive value (PPV) of different EHR-derived new user definitions to identify true incident use (no prior claims). We then assessed how often index EHR prescriptions that met a definition of new use resulted in primary nonadherence (no subsequent claims). Overall, 12,405 index EHR prescriptions were identified with PPVs of 0.59 to 0.67 for true incident use. PPVs increased to 0.76 to 0.85 by excluding medications listed during the EHR medication reconciliation process and further increased to 0.87 to 0.93 by requiring ≥12 elapsed months since the first rheumatology office visit. Primary nonadherence at three months was observed in 33% to 38% overall and varied substantially by medication class, ranging from 15% to 23% for conventional synthetic disease-modifying antirheumatic drugs (DMARDs) to 54% to 64% for targeted synthetic DMARDs. New DMARD use was accurately distinguished from prevalent use with EHR prescriptions and simple new user definitions that include current medications collected during medication reconciliation. Primary nonadherence was frequent and varied by DMARD class. This has important implications for epidemiologic studies using EHR data and for optimal delivery of clinical care.

Implementation of pharmacy-led preoperative medication reconciliation in surgical oncology patients

BackgroundPharmacy-led medication history collection and reconciliation have demonstrated decreased medication errors, increased patient safety, and improved cost-savings. However, literature lacks documented efforts to implement such services in the preoperative space, where having accurate medication lists following complex procedures with high postoperative admission rates is critical. ObjectivesThe purpose of this study was to describe the implementation of a telephonic pharmacy student and pharmacist-led preoperative medication reconciliation program. Practice descriptionThe service was piloted using third- and fourth-year pharmacy students to conduct telephonic medication histories for urologic surgical oncology patients. Weekly reports identified eligible patients with scheduled procedures within 2 weeks’ time. Using standardized methods for patient communication and documentation, students authored telephone encounter notes that were reviewed and signed by pharmacist preceptors. Pharmacist preceptors also reconciled home medication lists based on students’ findings. Practice innovationA standardized preoperative medication reconciliation process was developed and implemented utilizing third- and fourth-year pharmacy students. Resulting notes were available for surgical staff on the day of patients’ procedures and upon potential postoperative admission. Evaluation methodsA retrospective chart review was conducted to evaluate successfully documented medication histories collected by pharmacy students within the pharmacy-led preoperative medication reconciliation program. ResultsForty-six medication reconciliation notes were identified between August 2021 and February 2022, and 39 met inclusion criteria. Amongst the 177 medication additions, deletions, and edits, deletions were the most common, and 95% of patients had at least 1 medication discrepancy identified. A total of 33 medication classes were represented by the identified discrepancies, and each encounter took an average of 33 minutes to complete. ConclusionPreoperative medication reconciliation services can be successfully accomplished through a telephonic pharmacy student and pharmacist-led workflow. Accurate medication histories aid in minimizing medication errors and increasing patient safety.

1286: AVOIDING A “MED WRECK”: DRIVING CHANGE AND IMPROVEMENT WITHIN THE MEDICATION RECONCILIATION PROCESS

1286: AVOIDING A “MED WRECK”: DRIVING CHANGE AND IMPROVEMENT WITHIN THE MEDICATION RECONCILIATION PROCESS

A cross-sectional study of hospital pharmacists communicating medication changes at discharge

Abstract Introduction Medication discrepancies can happen at transitions of care and there are recognised problems with the content of discharge letters.1 We introduced a discharge medication reconciliation process that was shown to improve the quality of medication information in discharge summaries.2 This involves pharmacists recording any changes to patient’s medication in the electronic prescribing system during the inpatient stay and summarising these changes on discharge in a discharge medication reconciliation (DMR) note. Though this is part of routine clinical pharmacy practice we have not directly quantified these notes in comparison to standards for the clinical structure and content of patient records,3 nor have we examined which medication classes are commented upon by our pharmacists. Aim To characterise the type of medication changes that pharmacists describe and the classes of medication that warrants such attention. Methods A retrospective study of a purposive sample of 100 patient episodes where a DMR note was recorded at a 750-bed teaching district general hospital in England. We classified the text of the DMR note using the four categories (added, amended, on hold, and discontinued) in the eDischarge Summary Standard,3 plus four further categories. The actual medication named was categorised according to the main BNF therapeutic chapters. Data were collated and analysed using Microsoft Excel. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database. Results Data were extracted for 100 discharges from early 2023. The mean age was 70 years (range 12 to 96), and 40% were male. In total, 352 medicines were named in the DMR notes with 184 (52%) recorded as added, 41 (12%) amended, 32 (9%) on hold, and 42 (12%) discontinued. For 32 (9%) instances the DMR note specifically referred to continuation of medication; in 12 (3%) instances to monitoring required; and 22 (6%) instances fell into other category. For 33 (33%) of episodes there was a note indicating that no changes had been made to other pre-admission medication during the hospital stay. Of the medication attracting a DMR note, the main chapters were cardiovascular 162 (46%), gastrointestinal 45 (13%), central nervous system 40 (11%), and 28 (8%) each for infection and for blood and nutrition. Discussion/Conclusion For this sample of patients who undergo a DMR process, the pharmacy team clarified medication changes at a mean rate of 3.5 changes per patient. Addition of medication was the most common event. The most frequent class of medication attracting a DMR note may be a reflection of the cardiovascular morbidities of patients as well as perceived adverse effects as 27/32 ‘on hold’ notes were for cardiovascular medication. Limitations of this study include the patient sample being collected in one hospital, hence results may not be generalizable. There was no attempt to ascertain if the DMR notes added value to primary care medicines reconciliation process.

Development and feasibility of an educational module on medication reconciliation for hospital pharmacists in the United Arab Emirates: a pilot study

Abstract Background The practice of medication reconciliation by pharmacists is minimal in United Arab Emirates hospitals. Objectives To design an educational module for pharmacists on medication reconciliation and assess its feasibility. Methods The study consisted of three parts: A pre-educational module survey using a validated knowledge, perception, practice, and barriers questionnaire (Cronbach’s α = 0.78), delivery of the educational module, and participants’ feedback. An educational module (general introduction to medication reconciliation, what is medication reconciliation, how to do medication reconciliation, and practicing medication reconciliation) was developed based on Miller’s pyramid and validated by three experts and pilot-tested. The knowledge and perceptions of pharmacists were evaluated by comparing pre-post educational module survey results. Results The module influenced the participants’ knowledge and perception of medication reconciliation. All of the participants gave ‘positive’ feedback on the intervention and the methodology applied, and they agreed on the need for training and workshops related to medication reconciliation. In addition, all ‘agreed’ that a lack of knowledge about medication reconciliation is the biggest barrier to medication reconciliation practices. The results further illustrated that all pharmacists had a ‘positive’ experience and ‘agreed strongly’ on understanding the majority of the content. Conclusion This study was successful in answering the research question by enrolling suitable participants, managing the timeline, and possessing resources for completing the study and hence considered feasible. This module can be utilized in continuous professional development programs to improve pharmacists’ knowledge, perceptions, and practice toward the medication reconciliation process aiming to reduce drug therapy-related problems in hospital settings.

Transitions of care from the womb to the world: Implementation of inpatient neonatal med rec

BackgroundMedication use during pregnancy is common. Safety of fetal medication exposures is an important consideration for pregnancy and for pharmacologic management and care of newborns. ObjectivesThe objective of this study was to describe the impact of implementing a neonatal medication reconciliation service at an acute-care hospital. Practice descriptionA neonatal medication reconciliation process was implemented at the University of New Mexico Hospital, a level 4 maternity center in a 500-bed academic medical center. Pharmacy personnel identified inpatient pregnant and postpartum patients who required medication reconciliation. In addition to performing maternal medication reconciliation, clinically significant medication exposures that occurred during pregnancy were recorded for neonates. Practice innovationOur neonatal medication reconciliation process evaluated prenatal “medication use” via a maternal medication history. We considered our medication reconciliation to be occurring during a “transition” from in utero to being born, which, to the best of our knowledge, has not been commonly reported as a transition of care in which pharmacists may play a role. Evaluation methodsWe conducted a retrospective descriptive chart review of patients who had both maternal and neonatal medication reconciliation services performed. We collected demographics, comorbidities, medications, and clinically significant exposures from the medication reconciliation note. ResultsA total of 384 charts were included in the final analysis. Of these, 167 medication reconciliations (43.5%) identified at least one medication history problem and 97 medication histories (25.3%) identified at least one potentially clinically significant neonatal medication exposure. Practice implicationsAlthough several limitations exist, a neonatal medication reconciliation process can be implemented in any inpatient setting with pharmacy staff available to perform and record reconciliation. ConclusionOpportunities for pharmacist involvement in pregnancy, postpartum, and neonatal care are expected to increase. Further research is warranted to more clearly determine the maternal and neonatal benefits of this medication reconciliation process and to link fetal exposures to outcomes.

Pharmacists' medication reconciliation interventions during admission and transfer from an emergency department at a tertiary care hospital: a randomized pilot study and evaluation of physician and patient perceptions.

The study aimed to assess the impact of pharmacist interventions during the transition of care. Medication discrepancies can occur at various levels of transition, such as during admission, the transition from emergency to special wards or from special to general wards, and during discharge. Discrepancies can be detected through the process of medication reconciliation. The objective of the study was to compare discrepancies among patients exposed to pharmacist intervention groups and those who were not and assess the perception of healthcare professionals and patients towards integrating pharmacists in the transition care process. A pharmacist-led interventional study was conducted for six months on patients above 18 years of age and either sex who were admitted to the emergency department, had chronic diseases, and subsequently transferred to another department (any). The patients were randomized into intervention and control groups. The pharmacist performed a medication reconciliation and medication review to identify discrepancies in every transition in both the groups, and then reported to the treating physician to resolve in the intervention group. Among the 73 patients recruited in the study, 152 discrepancies were identified. The total discrepancies observed in the control and intervention groups were 78 (51.3%) and 74 (48.6%), respectively. The majority, 35.53%, were found during the transition from emergency to special wards. The physician, upon pharmacist recommendations, accepted and resolved 48 discrepancies in the intervention group. The healthcare professional acceptance rate of pharmacist interventions was 64.86%. The transitions of care are at risk for errors due to medication discrepancies, and pharmacists could potentially identify and resolve discrepancies. Healthcare professionals and patients reported to be satisfied by the involvement of clinical pharmacists in the healthcare team.

Prescription Error

Objective: This research study aimed to investigate prescription errors and their intervention outcomes at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, during the year 2023. The study assessed the prevalence of prescription errors, identified contributing factors, evaluated the effectiveness of medication safety interventions, and examined the impact of adverse drug events on patient outcomes and healthcare costs. Methods: A cross-sectional study design was employed, and data were collected from the hospital's prescription files. Prescription errors were classified into various categories, and the frequency and proportion of errors were calculated. The study also evaluated different medication safety interventions' effectiveness in reducing prescription errors and assessed healthcare professionals' adherence to medication safety protocols. Additionally, the study conducted a cost analysis of adverse drug events to assess their financial implications. Results: The study revealed a prescription error rate of 25.1%, with wrong dosage, drug omission, drug-drug interactions, and illegible prescriptions being the most common error categories. Adverse drug events resulting from prescription errors affected 12.2% of patients, leading to patient harm and increased healthcare utilization. The electronic prescribing system emerged as the most effective intervention, reducing prescription errors by 60.1%. High adherence rates were observed for double-checking high-risk medications and conducting medication safety huddles. However, there was room for improvement in implementing barcoding technology and tall man lettering. Conclusion: Prescription errors and adverse drug events pose significant challenges to medication safety at Zewditu Memorial Hospital. Implementing electronic prescribing systems and enhancing medication reconciliation processes can significantly reduce prescription errors and improve patient outcomes. Furthermore, fostering a culture of safety, promoting interprofessional collaboration, and investing in education and training programs are essential to enhance medication safety practices. Continuous quality improvement initiatives and regular audits should be conducted to address medication safety challenges and support a culture of learning from errors. Policymakers should be engaged to support medication safety initiatives, and multi-center studies are recommended to enhance generalizability.

Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: a multicentre study

There is potential for many medication errors to occur due to the complex medication use process. The medication reconciliation process can significantly lower the incidence of medication errors that may...

Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals' Perspectives.

The WHO established that medication errors are the most common and preventable errors and represent an expenditure of 42 billion U.S. dollars annually. The risk of medication errors increases in transitions between levels of care, mainly from hospital care to primary healthcare after hospital discharge. In this context, communication is a key element in the safety of the medication reconciliation process. The aim of this paper was to describe the barriers to, and facilitators of, effective communication during the medication reconciliation process at hospital discharge in people over 65 years of age, from the perspective of primary healthcare professionals. A qualitative descriptive study was designed, and in-depth interviews were conducted with 21 individuals, of whom 13 were nurses and 8 were physicians. This study was carried out with healthcare professionals belonging to primary healthcare centres in Huelva (Spain). Following content analysis of the discourses we identified 19 categories, grouped into three areas: interlevel communication, communication between primary healthcare professionals, and communication between healthcare professionals and patients/caregivers. The barriers found mainly relate to the adequacy and use of technological tools, time available, workload and the level of collaboration of patients/caregivers. Facilitating elements for communication in medication reconciliation included technologies, such as computerized medical history, protocolization of clinical sessions, the presence of case management nurse and interdisciplinary teamwork.

Exploring the Accuracy of the Medication Reconciliation Process on the Medical Floor

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Impact of pharmacist‐led discharge medication reconciliation at an Academic Medical Center

AbstractPrior studies evaluating the impact of pharmacist‐led discharge medication reconciliation have demonstrated higher rates of medication discrepancy detection and intervention with variable effects on hospital readmission. The purpose of this study was to evaluate the impact of a newly developed pharmacist‐led hospital discharge medication reconciliation process implemented with an interdisciplinary Internal Medicine Service. This was a retrospective, single‐center, pre‐post observational cohort study. Institutional review board approval was obtained. The primary end point was quantification and categorization of medication discrepancies identified on the hospital discharge medication list. Secondary end points included characterization of interventions made during the discharge medication reconciliation process, and 30‐day hospital readmission rates that were adjusted using a multivariable logistic regression model. A total of 144 patients were included in the pharmacist‐led discharge medication reconciliation intervention group and 144 patients were included in the historical control. There was a statistically significant four‐fold reduction in the number of medication discrepancies identified on discharge medication lists in the intervention group (77 vs. 18 in the historical control vs. intervention groups, respectively; p &lt; 0.0001). When adjusted for length of stay (L), acuity of the admission (A), comorbidity of the patient (C), and emergency department use in the last 6 months (E) (LACE) index and age, the adjusted odds ratio (aOR) for 30‐day readmission was 0.51 (95% confidence interval: 0.27–0.95) in the intervention versus the historical control group. Implementation of an interdisciplinary pharmacist‐led discharge medication reconciliation program was associated with a significant reduction in medication discrepancies on the discharge medication list, as well as a reduction in the adjusted odds of 30‐day hospital readmission.

Results of a Pilot Study for a Pharmacy Discharge Review in Neurosurgical Patients: A Quality-Safety Initiative.

Objective A multidisciplinary collaboration between the neurosurgical team and the pharmacy was established to conduct a pilot study in which discharged neurosurgical patients from a community hospital would receive medication reconciliation services and counseling by a pharmacy specialist to determine the impact on patient safety, readmission rates, and medication compliance. Methods Pharmacists reviewed discharge medication reconciliations of neurosurgical patients to address any discrepancies with the nurse practitioners or physicians prior to discharge and provided discharge medication counseling to the patient/families at the bedside. The service was provided on weekdays during the eight-hour pharmacist shiftin addition to other daily responsibilities. Data were analyzed by type and the total number of pharmacy interventions encountered during the discharge medication reconciliation process, time to complete services, and readmission rates. Lastly, the discharged neurosurgical patients that were not seen by pharmacists during the one-month pilot study were reviewed retrospectively to determine potential interventions. Results A total of 48 neurosurgical patients were discharged during the one-month pilot study; 27 patients received discharge medication reconciliation services and counseling from the pharmacy specialists. Sixty-three pharmacy interventions were accepted with prevention of medication errors/adverse drug reactions (21%, n=21) and addition of missing medication (21%, n=21) being the most common intervention types. The mean time to complete the services was 27 minutes and there was one non-medication-related readmission of the 27 patients seen. Twenty-one neurosurgical patients who were discharged without receiving services were reviewed retrospectively. It was determined that there was a potential for another 64 pharmacy interventions in which clarification of indication (33%, n=21) was the most common intervention type, followed by prevention of medication errors/adverse drug reactions (25%, n=16) and addition of missing medication (22%, n=14). There was a total of one medication-related readmission of the 21 patients not seen by the pharmacist during the pilot study. Conclusion The collaboration of pharmacists in the discharge process benefits neurosurgical patients by reducing the number of discrepancies when transitioning home and provides an additional layer of safety to reduce medication errors and/or prevent adverse events.

Conciliation médicamenteuse et sécurisation de la transition hôpital–ville : enquête auprès des pharmaciens d’officine

To collect the community pharmacists' perception on their role in the medication reconciliation's process. We did an observational transverse study thanks to a survey of community pharmacists working in France, conducted in 2020. A digital questionnaire was submitted to Parisian community pharmacists before being shared on two Facebook groups. The responses were analysed with Microsoft Excel® software. We calculated percentages, used Chi2or Fisher's exact tests and did qualitative analyses. We collected the perception of 135community pharmacists, the majority was women (80%), relatively young (69.6% of 40years old or less). They were 63.7% to claim knowing the medication reconciliation, but they could not define it properly. The subject's knowledge was statistically related to age (P-value<0.001) and previous contacts of the health care facilities (P-value<0.001). The majority of interviewed pharmacist considered the transmission of information to those health facilities as relevant and feasible and they expressed their willingness to get involved. However, they were limited by some obstacles such as the non-exhaustiveness of the medicinal record, the unsecured mail and the lack of feedbacks. Although the community pharmacists expressed interest for the medication reconciliation process and willingness to get involved, their role remained limited. Therefore, this process needs an improvement of its organisation and a generalisation of its practice to really benefit the hospital-community transition's safety.