ArticleEuropean journal of hospital pharmacy : science and practice2019
Medication reconciliation in a Swiss hospital: methods, benefits and pitfalls.
Article in European journal of hospital pharmacy : science and practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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Who cites it
5 citing papers in PubMed, 18 citations in OpenAlex.
- Sources of medication omissions among hospitalized older adults with polypharmacy.Journal of the American Geriatrics Society · 2022Trial
- Development and evaluation of a patient-centric approach for accurate medication capture.JAMIA open · 2025Article
- The value of incorporating patient-consulted medication reconciliation in influencing drug-related actions in the outpatient rheumatology setting.BMC health services research · 2022Observational
- Usability and perceived usefulness of patient-centered medication reconciliation using a personalized health record: a multicenter cross-sectional study.BMC health services research · 2022Article
- Risk factors for clinically relevant deviations in patients' medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting.International journal of clinical pharmacy · 2022Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the feasibility and main obstacles to the implementation of a medication reconciliation (MR) process in a Swiss hospital and to develop a standardised method which can be used in similar healthcare systems.
methodsFor this prospective, observational single-centre and single-ward study, a best possible medication history (BPMH) was established by a clinical pharmacist for 147 patients with heart failure based on two sources and a patient interview for each case. Identified discrepancies with medication histories established during emergency service were conveyed to the ward physician. At the end of each hospital stay, the planned discharge treatments were compared with the BPMHs to identify discrepancies and to propose modifications. After a final validation, the comparative treatment plans were distributed.
resultsMR was conducted for 120 (82%) patients and the mean time needed was 74 min/patient. At least one discrepancy was identified among 94% of the patients on admission, with 4.1 discrepancies found per patient (mainly omissions). At discharge, 83% of the patients had at least one discrepancy, with 2.3 discrepancies found per patient (mainly unintentional substitutions). The majority (86%) of pharmaceutical interventions to adjust the discharge prescriptions were accepted by the physician.
conclusionsA standardised method of MR which offers precise definitions of discrepancies and key tools for the process was developed. This method was applicable to most of our cohort and it effectively identified medication discrepancies. Two potential obstacles for its implementation are the time needed for MR and the questionable impact of pharmaceutical interventions on discrepancies.
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