Pharmacist-led interdisciplinary medication reconciliation using comprehensive medication review in gynaecological oncology patients: A prospective study
JournalEuropean Journal of Hospital Pharmacy
PublisherBMJ Publishing Group
MetadataShow full item record
AbstractObjectives: Medication reconciliation is a key part of transitional care. This study examined the implementation of a pharmacist-led medication reconciliation programme for short-term hospitalised patients and explored the barriers and benefits. Methods: A prospective study was conducted in patients admitted to a gynaecological oncology department. Medications were reconciled on admission using a 'comprehensive medication review (CMR)' strategy. Patients received a reminder text message and were asked to bring their medications a day before admission for scheduled chemotherapy. Upon admission, a pharmacist reviewed patients' admission prescriptions and home medications, including non-prescription medications, based on clinical status and laboratory test results. Drug-related problems and unused or expired medications were assessed. Satisfaction with the CMR service and reasons for non-compliance were surveyed by an individual interview. The cost of the unused or expired medications was calculated based on the average drug acquisition cost. Results: Sixty-four interventions in 95 patients were performed during the study - namely, correction of treatment duration (34 cases, 53.1%), recommendation of medications for untreated indications (18 cases, 28.1%), correct drug selection (5 cases, 7.8%), discontinuation of duplicate medications (4 cases, 6.3%), correction of dose, provision of alternatives for drug-drug interactions, unintended omissions (1 case each, 1.6%). The difference in the cost of unused or expired drugs before and after programme implementation was about US$1700. Conclusions: Pharmacist-led medication reconciliation targeting short-term hospitalised patients improved drug use, prevented medication waste and reduced healthcare costs. Copyright 2018 Published by the BMJ Publishing Group Limited.
Keywordcomprehensive medication review
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85049258873&doi=10.1136%2fejhpharm-2016-000937&partnerID=40&md5=a07208299b4b79a48f663a74910d0e2e; http://hdl.handle.net/10713/9189