Data collection and outcomes
The demographic characteristics, clinical characteristics and
hospitalization records were collected. We used a standardized
medication reconciliation form to collect the sources used and the types
and the numbers of discrepancies for each reconciliation procedure. The
reconciliation team documented the time of data collection and
completing the form. The drugs were classified according to WHO
Anatomical Therapeutic Classification (ATC)[20].
The primary outcome of the study was the type, the frequency and the
associated risk factors of UMDs. The potential risk factors assessed
were as follows: age, sex, type of medical specialty, educational
status, living status, the number of drugs taken prior to admission, the
admitting physician’s experience (intern, resident or attending doctor),
the day of admission (working days,
weekends and holidays), the type of admission (planned or unplanned),
and patient’s understanding of
preadmission medications. The secondary outcome was to evaluate the
potential harms of errors prevented by pharmacist intervention.
Resources required to support the medication history and reconciliation
process were also evaluated.