Journal of Pharmaceutical Care 2016. 4(1-2):37-39.

Medication Reconciliation and Evaluation of Drug Discrepancies by a Pharmacist in Omid Hospital, Lali, Khouzestan
Leila Kouti, Asghar Davoodi, Kaveh Eslami, Maryam Aghakoochakzadeh


Background: Medication discrepancies occur at the time of medicine prescription in inpatient and outpatient settings, especially at patient transfer and discharge. Pharmacists can prevent these medication errors by reconciliation of the patients’ medications. In this study, medication discrepancies of the only hospital of a small town are assessed by a pharmacist.

Methods:A medication reconciliation form was designed to fully record all patients’ drug history and current therapies. All admitted patients during a six month interval were evaluated by a pharmacist and their medical records were compared to the detailed data form.

Results:150 admitted patients were evaluated in this study from September 2015 to February 2016. 51% of the patients were male and 49% female. 56% of the patients had medication discrepancies when discharged. Interestingly none of the patients had documented drug history in their medical records.

Conclusion:More than half of the patients developed a medication discrepancy at the time of discharge. We think that a drug review of the patients at the time of admission and discharge and establishing medication reconciliation processes may be helpful in improvement of health care.


Medication Reconciliation; Hospital ;Pharmacist

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