Impact of Pharmacists Directed Medication Reconciliation on Reducing Medication Discrepancies in a Surgery Ward in an Educational Hospital in Jordan

Impact of Pharmacists Directed Medication Reconciliation on Reducing Medication Discrepancies in a Surgery Ward in an Educational Hospital in Jordan

1. Introduction Medication reconciliation is a technique used by healthcare providers at different care settings in order to prevent medication errors. According to the Institute for Safe Medication Practices Canada, medication reconciliation is defined as "a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care". ISMP Canada has described the process of medication reconciliation as " a systematic and comprehensive review of patient's Best Possible Medication History (BPMH) to identify any possible medication discrepancies and to inform and enable prescribers to make the most appropriate prescribing decisions for the patient to solve identified discrepancies".

Pharmacists are the healthcare providers responsible for providing optimal pharmaceutical care services. Regular medication review and medication reconciliation, beside the development of patient care plan, are considered as important pharmaceutical care tools.The Institute of Medicine reports acknowledged pharmacists as an essential resource of information on medication safe use, and their vital participation during hospital rounds as it improves medication safety.

Currently, all hospitals have a pharmacy department to ensure that all patients receive their medications in the correct way by implementing the eight rights of medication administration (right patient, right medication, right dose, right route, right time, right documentation, right reason and right response). Clinical pharmacists can ideally influence physicians on their prescribing of medicines because they have the appropriate knowledge regarding therapeutics and are in continuous contact with them.Pharmacists have an important role in reducing discharge medical errors and patients' re-hospitalization.[6] Clinical pharmacists were found aware of the importance of their role in providing medication reconciliation.

Several previous studies have investigated the impact of a pharmacists-provided medication reconciliation service on medication discrepancies in the hospital settings Results showed that pharmacists were able to identify a range of 1.5-2.3 unintentional discrepancies per patient, leading to a significant reduction of 40-75% of the total identified medication discrepancies. No previous study has investigated the outcomes of involving the clinical pharmacist in a medication reconciliation service in in Jordan.