title: Effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients.
abstract: OBJECTIVE
  Pharmacists have been shown to improve medication reconciliation at hospital admission. Limited resources may obligate pharmacy departments to target resources for medication reconciliation rather than extend services to the entire hospital. We conducted a prospective, randomized, nonblinded assessment of the effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients.
  
  
  METHODS
  Eighty-one geriatric patients were randomized 1:1 to receive medication reconciliation per current hospital practice or to pharmacist-led medication reconciliation at admission. The primary end point was medication profile appropriateness by pharmacist review at 48 hours postadmission. Secondary end points involved in determining the impact and feasibility of this program.
  
  
  RESULTS
  Pharmacist-led medication was superior to standard hospital practice, with 48% of controls and 71% of intervention patients having appropriate medication profiles at 48 hours postadmission (P = .033). Pharmacists identified 116 discrepancies among 81 patients including predominantly omissions (41%) and a composite of wrong dose, route, or frequency (35%). Pharmacists spent a median 15 minutes per patient.
  
  
  CONCLUSIONS
  Pharmacists improved admission medication reconciliation for geriatric patients. Pharmacists identified a significant number of discrepancies, including predominantly omissions and wrong dose, dosage form, or frequency. Pharmacists' contributions to medication reconciliation could yield substantial benefit to patient care.
authors: Manchester College School of Pharmacy, Fort Wayne, IN 46805, USA. rdbeckett@manchester.edu
authors: Robert D
authors: RD
authors: Beckett
authors: Christopher W
authors: CW
authors: Crank
authors: Ann
authors: A
authors: Wehmeyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D006760:Hospitalization; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000379:methods* / Q000592:standards; D010595:Pharmacists / Q000523:psychology / Q000592:standards*; D010607:Pharmacy Service, Hospital / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D013997:Time Factors