title: A survey on patients medication reconciliation process in an oncological hospital.
abstract: The purpose of this study was to assess the impact of medication reconciliation in the clinical practice from a hospital pharmacist point of view.
  
  
  
  A survey of the medication taken by cancer patients was performed on admission and on discharge in an oncological hospital, and then the subjects were followed up until discharge for 8 weeks. The pharmacist entered the data collected into a computer based tool which, by using
  Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP criteria) and Micromedex™ interactions database, automatically produces a report indicating the possible inconsistencies. The report is to check all potentially inappropriate prescriptions (PIPs) correlated to the drugs assumption by the patient. The appropriateness of the medication was scored using a Medication Appropriateness Index (MAI index) which was used to reconcile the medication list accordingly.
  
  
  
  Patients reconciled at admission were 98, while patients reconciled at discharge were 90, 8 patients dropped out due to death. After the intervention of the hospital pharmacist, the average
  value of MAI index showed a significant reduction (3,391 to 2,552 p=0.039) and the median number of drugs prescribed per patient was decreased (7 vs 6; p=0.8058).
  
  
  
  Our study demonstrated that the forms used in the reconciliation process, in particular the record card, is a promising method to increase the quality of the information related to drug use in clinical decisions. We think that medication reconciliation softwares should be widely used by health care professionals involved in the recording of drug history or prescription process.
authors.affiliation: Hospital Pharmacy, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Frida
authors.initials: F
authors.lastname: Gorreja
authors.affiliation: Hospital Pharmacy, Veneto Institute of Oncology - IRCCS, Padua, Italy - School of Hospital Pharmacy, University of Padua, Italy.
authors.forename: Vera
authors.initials: V
authors.lastname: Damuzzo
authors.affiliation: Pharmaceutical Department, Local Health Unit n. 6 Euganea, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Gallo
authors.affiliation: Hospital Pharmacy, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Russi
authors.affiliation: Hospital Pharmacy, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lo Re
authors.affiliation: 3° Section - Ministry of Health, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Ciampalini
authors.affiliation: 3° Section - Ministry of Health, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Guidotti
authors.affiliation: School of Hospital Pharmacy, University of Padua, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Serena
authors.affiliation: Hospital Pharmacy, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Angelo Claudio
authors.initials: AC
authors.lastname: Palozzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D000066491:Clinical Decision-Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D059065:Medication Reconciliation / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010343:Patient Admission; D010351:Patient Discharge; D010595:Pharmacists / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D000067561:Potentially Inappropriate Medication List; D012984:Software; D011795:Surveys and Questionnaires; D055815:Young Adult