The Impact of Pharmacist-Led Medication Reconciliation in Surgical Ward targeting High Risk Patients

Introduction: Medication errors are highly prevalent upon hospital admission and discharge. Clinical pharmacist involvement in medication reconciliation is effective in identifying and rectifying medication errors. However, pharmacist involvement at all stages of the reconciliation process for every patient may not be feasible at individual institutions. This study evaluated a targeted approach in selecting high-risk patients in an effort to reduce unintended medication discrepancies.

Objectives: To determine the percentage of incidence and the severity of unintended medication discrepancies before and after targeting high risk patients in surgical wards.

Study Design: Quasi-experimental pre-post intervention study

Methods: This was a single-center, pre-post intervention study conducted at the surgical wards in the United Christian Hospital, Hong Kong. Following institutional review board approval, pre-intervention data (From ward A) were collected retrospectively over 3 months from December 2013 to February 2014; while post-intervention data (From ward A and B) were collected prospectively over 3 months from December 2014 to February 2015. The potential severity of the unintended medication discrepancies were rated by pharmacists and classified into 3 levels according to NCC MERP index.

Results: There was a non-statistically significant increase in the percentage of incidence from 5.32% to 7.35% (p-value 0.056) when comparing pre-intervention and post-intervention group. Statistical significance was shown when comparing ward A patients only in both groups, the percentage of incidence increased from 5.32% to 8.15% (p-value 0.021). There was no statistically significant difference in terms of the severity level of medication discrepancies between pre-intervention and post-intervention group (Ward A and B: p-value 0.295; Ward A only: p-value 0.388).

Conclusions: Targeting high risk patients in medication reconciliation process in surgical wards is a feasible approach given the limited time and resources available for pharmacists, resulting in a higher percentage of incidences of unintended medication discrepancies being detected, although the detected potential severity of the discrepancies may not be altered.