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4CPS-209 An exploration into a pharmacist-led medicines reconciliation service in an acute hospital setting
  1. C Shine1,
  2. M Kieran2,
  3. C Meegan3
  1. 1Mater Misericordiae University Hospital, Pharmacy Department, Dublin 7, Ireland
  2. 2MMUH, Pharmacy, Dublin, Ireland
  3. 3Mater Misericordiae University Hospital, Pharmacy, Dublin, Ireland


Background and importance Accurate medication records are essential in preventing errors, avoiding harm, aiding diagnosis and treatment planning. Prescribing errors are more prevalent on hospital admission1 2Medicines reconciliation (MR), ‘the formal process in which healthcare professionals partner with patients to ensure accurate and complete medication information transfer at interfaces of care’, ensures accurate medication record generation.3 MR is undertaken to varying degrees in many institutions, by a variety of healthcare professionals, each with their own focus, priorities and methods.4 MR is a WHO patient safety priority outlined in the High 5s Project.3

Aim and objectives To determine views and opinions of doctors towards a pharmacist-led MR service in an acute hospital and to ascertain what doctors identify as MR barriers and facilitators.

Material and methods A self-completion questionnaire using mixed methodology was conducted. This involved analysing data both qualitatively and quantitatively. Data were collected simultaneously. Inclusion criteria: all doctors working at the Mater Misericordiae University Hospital (MMUH). Exclusion criteria: none. Data were analysed on site using a password protected spreadsheet on Microsoft Excel. Detailed content and thematic analysis were performed to identify common concepts. A 10% proportion of the data was checked by an independent reviewer

Results The positive impact on patient care and safety demonstrated by MR was acknowledged by 98% (n=50): 94% (n=49) agreed MR saved them time while 92% (n=48) recognised MR decreased their workload, 90% (n=46) of participants were satisfied with the MMUH MR service and 94% (n=49) agreed MR was accurate. Participants called for dedication of pharmacy resources to MR (88%, n=46), and service expansion to include all patients on admission, care transition and discharge was advocated by participants (79%, n=41; 86%, n=44; and 79%, n=41, respectively). The most important facilitator was verbal communication of MR discrepancies. The most important barrier was current service limitations. Thematic analysis identified four themes: patient safety (n=33), workload implications (n=9), MR usefulness (n=52) and service development (n=56).

Conclusion and relevance Prescribers viewed the pharmacist-led MR service as a positive useful initiative, saving prescribers time, and increasing patient care and safety hospital wide.

References and/or acknowledgements 1. Porcelli PJ, Waitman LR, Brown SH. A review of medication reconciliation issues and experiences with clinical staff and information systems. Appl Clin Informatics 2010;1:442–461.

2. FitzGerald RJ. Medication errors: the importance of an accurate drug history. Br J Clin Pharmacol 2009;67:671–675.

3. World Health Organization. Standard operating protocol assuring medication accuracy at transitions in care, 2014.

4. Barnsteiner JH. Medication reconciliation. In: Hughes RG, editor. Patient safety and quality an evidence-based handbook for nurses 2008;38:2–459.

No conflict of interest.

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