Conclusion
In conclusion, medication reconciliation implementation program
conducted by clinical pharmacists revealed a significant rate of
medication discrepancies in patients at admission, more than two thirds
of which were likely to cause moderate to severe discomfort or clinical
deterioration. Polypharmacy on the BMPH and 2 or more chronic diseases
at admission were recognized as risk factors for UMDs. Future studies
could examine medication reconciliation process at other transitions,
such as hospital discharge and inter-hospital transfer. And cost-benefit
analysis from the implementation of medication reconciliation by
pharmacists will also need to be exploded.
Acknowledgements None.