Avicenna Journal of Pharmaceutical Research

Background: Medication reconciliation is the process of comparing a patient’s medication orders in the hospital with the patient’s history of medications used prior to admission. The main purpose of this study was to investigate the effect of drug reconciliation by clinical pharmacists on preventing or reducing medication errors in patients with heart failure during admission.

Methods: This prospective study was conducted at Farshchian Heart Hospital, Hamadan University of Medical Sciences, over 6 months. Demographic characteristics and treatment details of patients in the admission phase and data related to pharmaceutical activities were collected and analyzed by clinical pharmacists.

Results: Drug combination was performed in 290 patients. At least one medication discrepancy was observed in 169 patients. The most common types of reconciliation errors were “omission” (n=163, 48.9%) and “dose” (n=71, 21.3%), respectively. About 30% of the identified unintentional inconsistencies had the ability to cause moderate to severe harm to the patient. Organized clinical physician-pharmacist recommendations were reported to be nearly 85%, and about 80% of patients were satisfied with the services provided by pharmacists during their hospitalization.

Conclusion: Our findings demonstrated that pharmacist involvement in hospital care transitions had a positive effect on reducing medication errors in heart failure. Patients with relatively complex medication regimens benefited from continuity of care, including receiving services from a clinical pharmacist during the transition of care.