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.