Types Of Medication Errors Research Articles

The Relationship Between Work Commitment, Dynamic, and Medication Error.

Incidence of medication errors in intensive care unit (ICU) can cause irreparable damage for ICU patients. Therefore, it seems necessary to find the causes of medication errors in this section. Work commitment and dynamic might affect the incidence of medication errors in ICU. To assess the mentioned hypothesis, we performed a descriptive-analytical study which was carried out on 117 nurses working in ICU of educational hospitals in Tehran. Minick et al., Salyer et al., and Wakefield et al. scales were used for data gathering on work commitment, dynamic, and medication errors, respectively. Findings of the current study revealed that high work commitment in ICU nurses caused low number of medication errors, including intravenous and nonintravenous. We controlled the effects of confounding variables in detection of this relationship. In contrast, no significant association was found between work dynamic and different types of medication errors. Although the study did not observe any relationship between the dynamics and rate of medication errors, the training of nurses or nursing students to create a dynamic environment in hospitals can increase their interest in the profession and increase job satisfaction in them. Also they must have enough ability in work dynamic so that they don't confused and distracted result in frequent changes of orders, care plans, and procedures.

Evaluating Medication Errors for Hospitalized Patients : The Jordanian Experience = تقييم الأخطاء الدوائية لمرضى المستشفى : التجربة الأردنية

To investigate the rate, frequency, and severity of medication errors detected by a clinical pharmacist at a teaching hospital in Amman, Jordan. Secondly, to determine the risk factors associated with the occurrence of these errors. This prospective observational study used two methods of medication error detection, direct observation and the chart review method. Both methods were conducted in the internal medicine ward between June and December 2013. In the selected shifts, all procedures performed on the patients were observed and recorded by the clinical pharmacist. The number and types of medication errors were documented. Risk factors associated with more medication errors were then tested using multiple univariate regression to identify potential risk factors. All collected data were entered into SPSS and analyzed accordingly. The study included 283 patients and 15 nurses. A total of 803 medication errors per 6396 opportunities for errors (12.6%) were observed. The most frequent errors were administration errors (n= 739, 20.2%), transcription errors (n= 40, 1.5%), dispensing errors (n= 21, 0.8%) and prescribing errors (n= 3, 0.1%). Risk factors associated with the total number of detected medication errors were mainly shorter nurse's experience in the ward (R2 = 0.456, p< 0.042) and patients with higher number of prescribed doses (R2 = 0.451, p< 0.025). This study revealed that medication errors happening in a teaching hospital occur mainly during the administration and transcription stages of the medication use process. Shorter nurse experience and caring for inpatients with more complicated therapeutic regimens can lead to higher rates of medication errors.

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in a hospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied. Objectives. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medication errors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) and paediatric wards. Methods. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients’ medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered by the nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medication error checklist was used to collect the data. Results. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients had one or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequent type of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of these medication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives (43%) and analgesics (25%) had the most errors. In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%) patients the medication error resulted in some level of harm. Conclusion. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reported elsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem in paediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventive measures among the multidisciplinary team.

Economic impact of medication error: a systematic review.

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd.

Analysis of Medical Errors: A Case Study

Analysis of Medical Errors: A Case Study

The Effects of Bar-coding Technology on Medication Errors: A Systematic Literature Review.

The bar-coding technology adoptions have risen drastically in U.S. health systems in the past decade. However, few studies have addressed the impact of bar-coding technology with strong prospective methodologies and the research, which has been conducted from both in-pharmacy and bedside implementations. This systematic literature review is to examine the effectiveness of bar-coding technology on preventing medication errors and what types of medication errors may be prevented in the hospital setting. A systematic search of databases was performed from 1998 to December 2016. Studies measuring the effect of bar-coding technology on medication errors were included in a full-text review. Studies with the outcomes other than medication errors such as efficiency or workarounds were excluded. The outcomes were measured and findings were summarized for each retained study. A total of 2603 articles were initially identified and 10 studies, which used prospective before-and-after study design, were fully reviewed in this article. Of the 10 included studies, 9 took place in the United States, whereas the remaining was conducted in the United Kingdom. One research article focused on bar-coding implementation in a pharmacy setting, whereas the other 9 focused on bar coding within patient care areas. All 10 studies showed overall positive effects associated with bar-coding implementation. The results of this review show that bar-coding technology may reduce medication errors in hospital settings, particularly on preventing targeted wrong dose, wrong drug, wrong patient, unauthorized drug, and wrong route errors.

Identifying and quantifying weaknesses in the Closed Loop Medication Management System in reducing medication errors using a direct observational approach at an academic medical centre

AbstractBackgroundClosed Loop Medication Management System (CLMMS) is an end‐to‐end medication delivery system comprising seamless interfaces, independent verification processes and information feedback to improve safety and quality.AimFollowing implementation of a CLMMS at an academic medical centre in Singapore, this study was conducted to identify any safety issues and areas for quality improvement.MethodA direct observational study was conducted in the wards, inpatient pharmacy and unit‐dose satellite pharmacy. The numbers and types of medication errors in prescribing, supply and administration were observed and recorded to calculate the error rate. Events that have the potential to cause errors were also observed.ResultsThe prescribing error rate was 1.3% and the most common prescribing error was dose error. Supply error rate was 0.7% in which labelling error occurred most frequently. Workflow issues were the most common occurrences that could potentially cause prescribing and supply errors. The administration error rate was 7.3%, and wrong drug preparation technique was most commonly seen. Improper procedure in the use of personal digital assistant was the most common event that could potentially lead to an administration error.ConclusionThis study was instrumental in identifying important medication safety gaps in order to improve the inpatient CLMMS. Although a failure mode and effects analysis was performed prior to implementation of the system, unintended error types may still be introduced. Hence a post‐implementation audit is necessary to address such issues to ensure that the CLMMS objective of improving medication safety is achieved.

A comparative study of voluntarily reported medication errors among adult patients in intensive care (IC) and non- IC settings in Riyadh, Saudi Arabia

Purpose: To investigate the risk factors associated with medication errors and to compare the incidence and types of voluntarily reported medication errors among adult intensive care unit (ICU) and non-ICU patients at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: The design of this study was retrospective. All voluntarily reported medication errors involving adult patients (≥ 18 years) who were admitted into King Abdulaziz Medical City during the study period (January 2012 to June 2013) were included in the study. Reported medication errors were classified as ICU or non-ICU errors. Medication errors were also classified according to the node of medication use, harm category, and type of medication errors. Results: A total of 31,399 patients admitted into the hospital were included in the study, with 1,966 (6 %) admitted into the ICU and 29,433 (94 %) admitted into the non-ICU units. Overall, the incidence of medication errors was 1.2 % (390/31,399), 1. Over half of the errors were administration-related (51 %). The incidence of medication errors was 5.5 % (108/1,966) in ICU compared with 0.96 % (282/29,433) in non-ICU units ( p < 0.001. In both settings, prescribing errors, delay in drug administration and dispensing extra dose were the most common medication errors. Higher risk for medication errors was significantly associated with admission into ICU vs. non-ICU units [OR = 5.24, 95 % CI: (4.12, 6.65); p < 0.001] and with patients’ age ≥ 60 vs. < 60 years [OR = 1.48, 95 % CI: (1.19, 1.83); p < 0.001]. Conclusion: Medication errors are common in the health facility and occur during all stages of medication use from prescribing to administration. Higher risk for medication errors is associated with admission into the ICU and with patients’ age ≥ 60. Physician, pharmacists, and nurses need to be vigilant, up-to-date, and continuously trained to reduce the incidence of medication errors. Keywords: Medication errors, Voluntary reporting, Intensive care unit, Hospital setting

Restrictions on surgical resident shift length does not impact type of medical errors

BackgroundIn 2011, resident duty hours were restricted in an attempt to improve patient safety and resident education. With the goal of reducing fatigue, shorter shift length leads to more patient handoffs, raising concerns about adverse effects on patient safety. This study seeks to determine whether differences in duty-hour restrictions influence types of errors made by residents. Materials and methodsThis is a nested retrospective cohort study at a surgery department in an academic medical center. During 2013-14, standard 2011 duty hours were in place for residents. In 2014-15, duty-hour restrictions at the study site were relaxed (“flexible”) with no restrictions on shift length. We reviewed all morbidity and mortality submissions from July 1, 2013-June 30, 2015 and compared differences in types of errors between these periods. ResultsA total of 383 patients experienced adverse events, including 59 deaths (15.4%). Comparing standard versus flexible periods, there was no difference in mortality (15.7% versus 12.6%, P = 0.479) or complication rates (2.6% versus 2.5%, P = 0.696). There was no difference in types of errors between periods (P = 0.050-0.808). The most number of errors were due to cognitive failures (229, 59.6%), whereas the fewest number of errors were due to team failure (127, 33.2%). By subset, technical errors resulted in the highest number of errors (169, 44.1%). There were no differences between types of errors of cases that were nonelective, at night, or involving residents. ConclusionsAmong adverse events reported in this departmental surgical morbidity and mortality, there were no differences in types of errors when resident duty hours were less restrictive.

Bibliometric analysis of patient safety literature example of thesis and articles in Turkish

AbstractBibliometric analysis is a quantitative method that explores the properties and citation of scientific works written on specific topics. The aim of this study is to examine the thesis and articles about patient safety in Turkey with bibliometric method. For this purpose, 42 theses that can be reached from the National Thesis Center and 30 articles from the ULAKBIM and Google Scholar databases have been examined from a bibliometric point of view. In both types of scientific studies, culture and medical errors were mostly studied. The average number of citations for theses is 122.9, while for articles this number is 26.2. In the theses, 51,65% of the total 51,657 articles were published in journals, 15,2% in books, 15,5% in electronic publications, 6,8% in theses and 14,8% in other publications (newspapers, education, congress, etc.). In the case of the articles, 60,2% of the 818 citations were made to the journals, 12,4% to books, 11,2% to electronic publications, 7% to congresses and 8,9% to other publications (newspaper, education, thesis, etc.).

Medication Errors in Patients with Enteral Feeding Tubes in the Intensive Care Unit.

Objective:Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems.Methods:A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines.Findings:Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively.Conclusion:In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients’ pharmacotherapy, and more attention should be paid to this issue.

Towards patient safety: assessment of medication errors in the intensive care unit in a developing country’s tertiary care teaching hospital

ObjectivesTo determine the incidence, causes, patterns and outcomes of medication errors (MEs) in the intensive care unit.MethodsThe ME reporting system was established using the principles based on prospective, voluntary, open,...

Systematic Review of the Prevalence of Medication Errors Resulting in Hospitalization and Death of Nursing Home Residents.

Medication errors (MEs) result in preventable harm to nursing home (NH) residents and pose a significant financial burden. Institutionalized older people are particularly vulnerable because of various organizational and individual factors. This systematic review reports the prevalence of MEs leading to hospitalization and death in NH residents and the factors associated with risk of death and hospitalization. A systematic search was conducted of the relevant peer-reviewed research published between January 1, 2000, and October 1, 2015, in English, French, German, or Spanish examining serious outcomes of MEs in NHs residents. Eleven studies met the inclusion criteria and examined three types of MEs: all MEs (n=5), transfer-related MEs (n=5), and potentially inappropriate medications (PIMs) (n=1). MEs were common, involving 16-27% of residents in studies examining all types of MEs and 13-31% of residents in studies examining transfer-related MEs, and 75% of residents were prescribed at least one PIM. That said, serious effects of MEs were surprisingly low and were reported in only a small proportion of errors (0-1% of MEs), with death being rare. Whether MEs resulting in serious outcomes are truly infrequent, or are underreported because of the difficulty in ascertaining them, remains to be elucidated to assist in designing safer systems.

Frequency and Types of Medical Errors in Infectious Patients Referred to the Emergency Department of Imam Reza (AS) Hospital in Kermanshah, Iran (2014-2015)

Introduction: Medical errors have significant economic and clinical consequences and are considered as great challenges for the healthcare systems of different countries. With regard to the importance of medical errors, this study aimed to evaluate the frequency and type of medical errors in infected patients, admitted to the emergency department of Imam Reza (AS) Hospital in Kermanshah, Iran in 2014-2015. Materials and Methods: In this cross-sectional, descriptive study, we evaluated medical errors affecting infected patients, admitted to the emergency department of Imam Reza (AS) Hospital in Kermanshah, Iran. Data were collected, using a questionnaire including demographic and clinical information and type of medical errors. Results: Data were collected from 385 clinical records available at the emergency department of the hospital. In a total of 809 distinguished errors, the highest rates of error were as follows: medication errors (30%), CI 95%: 0.26-0.34), diagnostic errors (24.60%, CI 95%: 0.22-0.28), and admission for more than 6 h in the emergency room (14.34%, CI 95%: 0.12-0.16). Based on the findings, unnecessary prescription of antibiotics accounted for the highest percentage of medication errors (16.07%, CI 95%: 13.52-18.62). Conclusion: According to the results of the present study, errors in diagnosis and treatment were the most frequent medical errors. Therefore, it is necessary to plan on reducing the frequency of these errors.

Folie à Trois: Prescribers', Pharmacists', and Patients' Shared Delusion of Medication Reconciliation.

Folie à Trois: Prescribers', Pharmacists', and Patients' Shared Delusion of Medication Reconciliation.

THE EVALUATION OF THE RATE AND THE TYPE OF MEDICATION ERRORS AMONG NURSES

&lt;p&gt;ABSTRACT&lt;br /&gt;Objective: Since medication instructions are an important part of patients’ treatment process, neglecting the correct principles of medication&lt;br /&gt;instructions application can result in numerous problems such as unsuccessful treatment or failure and the emergence of lawsuit and complaint&lt;br /&gt;issues. The survey and the determination of the medication error types is the first step in preventing them and since the medication errors are&lt;br /&gt;common among the nurses according to the various studies and due to their importance the researchers decided to perform a study aiming at the&lt;br /&gt;survey of the rate and the type of the medication errors common among the nurses.&lt;br /&gt;Methods: This study is a descriptive research performed on 119 nurses from Zahedan training hospitals all of whom have been selected based on a&lt;br /&gt;random method in 2016. To gather the necessary information required for the current study, a two-part questionnaire was taken advantage of the first&lt;br /&gt;part of which was related to the demographic characteristics, and the second part was connected to the evaluation of the type of medication errors&lt;br /&gt;and reporting them. Finally, after the questionnaires were collected, the data were analyzed based on SPSS 19 software and descriptive statistics.&lt;br /&gt;Results: The participants average age was 28.86±6.45; 101 individuals were women and 87 individuals had passed courses on ethics. Furthermore,&lt;br /&gt;86 nurses had had an experience of medication error at least for 1 time. The highest mean score in the type of the medication error was related to&lt;br /&gt;“wrong infusion rate, wrong dosage, and administering several drugs without paying attention to the drug interferences.”&lt;br /&gt;Conclusion: In this study, the results indicated that the rate of the medication errors is a very high among the nurses. Therefore, to reduce the&lt;br /&gt;medication errors, there is a need for making serious decisions.&lt;br /&gt;Keywords: Medication error, Nurses, Zahedan.&lt;/p&gt;

Abstract PR581

Background & Objectives: Errors in drug administration are quite frequent during anesthetic practice, with a reported rate of one in every 113-450 procedures. Although most events do not result in serious consequences, some can cause severe injury or even death. Several factors contribute to these faults, including the anesthesiologist’s experience, multitasking, medication’s appearance, severity of comorbidities and kind of surgery. Aims of this study were to determine the incidence and type of medication error among Brazilian anesthesiologists and to identify the common causal factors. Materials & Methods: After approval of national ethical committee a link to an online survey form was mailed to all 9,731 members of the Brazilian Anesthesiologists’ Society. After formal consent, they were asked to report, voluntarily and confidentially, aspects related to the medication error event, like type of surgery, time of the day and nature of the mistakes during anesthetic procedures. Results: One thousand thirty seven anesthesiologists replied this survey (10,6%). Most of the responders had between 30 and 39 years old (38,88%) and less than 5 years of anesthesiologist practice (23,69%). The frequency of the participants who had experienced at least one drug error was 74,43% and 89,51% had at least one “near miss”. The events were more frequent at general surgery and during the day. The most common incidents were changing ampoules (69.46%), syringe swap (40.54%), incorrect dose (26.62%), repeating the same drug previously infused instead of the desired (8.24 %), injection in a non recommended rate (8.11%) and use of a drug that was contraindicated for the patient (12.16%). Only 8.89% injected a medication in a different route (e.g. epidural, arterial). The most frequent mistake was the injection of midazolam 5mg/ml instead of midazolam 1mg/ml. Although most adverse events were of minor consequence (79,46%), eleven anesthesiologists had report deaths (n = 8) or irreversible damage (n = 3). The similarity between the ampoules (61,35%) and personal distraction (52,68%) were the most contributing factors for the occurrences. Approximately 2/3 of respondents think that label ampoules with standard colors can reduce the incidence of medication errors. Conclusion: Most anesthesiologists experienced at least one drug error or a near miss. The most frequent error was an exchange of ampoules due to their similarity. These findings support the creation of a national policy for reporting and prevention of medication errors.

Obligation towards medical errors disclosure at a tertiary care hospital inDubai, UAE.

OBJECTIVE: The study aimed to identify healthcare providers’ obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families.DESIGN: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai.SETTING AND PARTICIPANTS: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure.RESULTS: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X2 = 5.1), and being a physician (X2 = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X2 = 9.8), and any type of medical error regardless the cause, extent of harm (X2 = 8.7). Variables included in the binary logistic regression model were; status (Exp β (Physician) = 0.39, 95% CI 0.16–0.97), gender (Exp β (Male) = 4.81, 95% CI 1.84–12.54), and medical errors during the last year (Exp β (None) = 2.11, 95% CI 0.6–2.3).CONCLUSION: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians’ apprehension and make them more comfortable with disclosure conversations.

Identifying Medication-Related Adverse Drug Events in Nursing Facilities in East Texas.

The purpose of this study was to identify the rate of adverse drug events (ADEs) and the percentage that cause harm in east Texas nursing facilities. In 2014, there were 1.4 million nursing facility residents in the United States, and approximately half take nine or more prescribed medications daily. Twenty percent of medication doses administered results in an error, putting almost half of all nursing home residents at risk for two or more medication errors daily. Close to two million medication error-related ADEs are estimated to occur in nursing facilities each year. Many ADEs lead to emergency department visits and hospitalization. A two-month retrospective medical chart review was completed in two medium-sized for-profit nursing facilities in rural east Texas on residents who consented or whose proxy consented to the study. The Nursing Home Adverse Drug Event trigger tool was used for chart reviews. This tool primary uses laboratory values and resident assessments to identify medication-related ADEs. A total of 58 charts were reviewed. There were from 2 to 13 ADEs identified per month at the nursing facilities during the study. This was extrapolated to 7.41 to 27.59 ADEs per 100 resident months. While no permanent harm or hospitalizations resulted from the identified ADEs, these findings in such a small sample size contribute to an elevated level of concern about ADE occurrence and prohibit generalizability of results. Further research is needed on a larger sample, as well as types of medication errors occurring, leading to strategies for preventing ADEs.

Exploring discharge prescribing errors and their propagation post-discharge: an observational study.

Background Discharge prescribing error is common. Little is known about whether it persists post-discharge. Objective To explore the relationship between discharge prescribing error and post-discharge medication error. Setting This was a prospective observational study (March-May 2013) at an adult academic hospital in Ireland. Method Patients using three or more chronic medications pre-admission, with a clinical pharmacist documented gold-standard pre-admission medication list, having a chronic medication stopped or started in hospital and discharged to home were included. Within 10-14days after discharge a gold standard discharge medication was prepared and compared to the discharge prescription to identify differences. Patients were telephoned to identify actual medication use. Community pharmacists, general practitioners and hospital prescribers were contacted to corroborate actual and intended medication use. Post-discharge medication errors were identified and the relationship to discharge prescribing error was explored. Main outcome measured Incidence, type, and potential severity of post-discharge medication error, and the relationship to discharge prescribing. Results Some 36 (43%) of 83 patients experienced post-discharge medication error(s), for whom the majority (n=31, 86%) were at risk of moderate harm. Most (58 of 66) errors were discharge prescribing errors that persisted post-discharge. Unintentional prescription of an intentionally stopped medication; error in the dose, frequency or formulation and unintentional omission of active medication are the error types most likely to persist after discharge. Conclusion There is a need to implement discharge medication reconciliation to support medication optimisation post-hospitalisation.