title: Pharmacist-conducted medication reconciliation at hospital admission using information technology in Taiwan.
abstract: OBJECTIVE
  Obtaining an accurate medication history upon admission to the hospital can be challenging and time-consuming. This study evaluated the efficacy of a medication reconciliation program, conducted by pharmacists, with the assistance of medication usage data from the Taiwan National Health Insurance (NHI). Characteristics of patients at high risk for drug discrepancies were also determined.
  
  
  METHODS
  Patients admitted between May 2008 and September 2009 were recruited. The type and class of medication discrepancies reported by pharmacists, the medication discrepancy rate, physician acceptance rate, and time taken for the intervention were studied. The degree of harm that could have resulted from the discrepancies was independently evaluated by four pharmacists. The association between selected variables and the occurrence of drug discrepancies was analyzed.
  
  
  RESULTS
  Among 3013 patients interviewed, the pharmacists identified 243 patients (8%) with at least one medication discrepancy between the patient's medication history and admission orders. There were 576 discrepancies identified. About 19% of the errors prevented could have potentially caused moderate to severe harm. The average time for one intervention was 18±9.8min. The number of preadmission medications, age, frequency of outpatient visits within 3 months prior to this hospital admission, and the number of specialist outpatient clinics the patient had visited within 3 months before the admission were determined to be risk factors for drug discrepancies.
  
  
  CONCLUSIONS
  This medication reconciliation program, conducted by pharmacists, was made more efficient by medication usage data from the Taiwan NHI. Pharmacists can reconcile medications more effectively by selecting patients at high risk for unintentional drug discrepancies.
authors: Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taiwan.
authors: Yen-Ying
authors: YY
authors: Lee
authors: Li-Na
authors: LN
authors: Kuo
authors: Yi-Chun
authors: YC
authors: Chiang
authors: Jing-Yi
authors: JY
authors: Hou
authors: Tzu-Ying
authors: TY
authors: Wu
authors: Min-Huei
authors: MH
authors: Hsu
authors: Hsiang-Yin
authors: HY
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008490:Medical Informatics; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D010343:Patient Admission; D010595:Pharmacists; D013624:Taiwan; D055815:Young Adult