Medication reconciliation at admission by pharmacists in a teaching referral hospital in Iran

Medication errors may prolong hospitalization period, enhance its costs and make harmful impacts on health. Inappropriate drug history taking is a type of medication errors which may occur on admission, resulting in medication discrepancies. This work presents a report of discrepancies between the drug history acquired by pharmacists and the drugs administered by the physicians at a teaching hospital in Shiraz, Iran. This prospective study was conducted from October 2016 to March 2017 in 7 wards of Namazi hospital affiliated to Shiraz University of Medical Sciences. Both the physicians/nurses and pharmacists obtained medication history from patients recruited in this study during the first 24 hours of their admission. The medications were classified according to the ATC classification. Totally, 103 patients were recruited and 557 medications were recorded in this study. The mean±standard deviation age of patients was 58.52±18.75 years. Comparing pharmacist drug history with medication lists obtained by nurses or physicians revealed 353 discrepancies. On average, 3.42 discrepancies were identified per patient (ranged from 0 to 12). Most (85.8%) of medication discrepancies were related to omission errors. Metformin and aspirin were the most common medications involved in omission errors. The rate of medication discrepancies at admission in our hospital was high. Active contribution of pharmacists and providing accurate medication histories at the time of hospital admission can be considered as possible solutions for this problem.