PT  - JOURNAL ARTICLE
AU  - Heeyoun Son
AU  - Jeongmee Kim
AU  - Caroline Kim
AU  - Jonathan Ju
AU  - Youngmee Lee
AU  - Sandy Jeong Rhie
TI  - Pharmacist-led interdisciplinary medication reconciliation using comprehensive medication review in gynaecological oncology patients: a prospective study
AID  - 10.1136/ejhpharm-2016-000937
DP  - 2018 Jan 01
TA  - European Journal of Hospital Pharmacy
PG  - 21--25
VI  - 25
IP  - 1
4099  - http://ejhp.bmj.com/content/25/1/21.short
4100  - http://ejhp.bmj.com/content/25/1/21.full
SO  - Eur J Hosp Pharm2018 Jan 01; 25
AB  - Objectives 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.