• Piengjai Kiettanawattana Department of Pharmacy, Songklanagarind Hospital, Songkla


medication reconciliation, medication discrepancy, medication error


Hospitalized patients are prone to medication errors (MEs) which usually occur at transition points during care. Communication problems or the transfer of information between patients and healthcare professionals are among the causes of MEs. This study developed a medication reconciliation system with pharmacists who were specifically responsible for identification of medication discrepancy and intervention. This action research on patient admissions at Songklanagarind Hospital between October 2018 - September 2022 is divided into 4 phases: 1. Designed and developed medication reconciliation system with pharmacists in collaboration with a multidisciplinary team. 2. Conducted trial with one pharmacist and piloted it among patients with a previous history of using warfarin. 3. Developed medication reconciliation program. 4. Expanded the program to patients who are at risk of MEs by increasing the number of pharmacists to two. 70-78% of patients had medication reconciliation processed by a pharmacist within 24 hours of hospital admission. Pharmacists found MEs of 11-17%, with the most common being the incorrect dosage or frequency of medication (50-70%), followed by omission (15-45%). In 70-77% of the MEs, the medication did not reach the patient. Pharmacists have an important role in preventing MEs by reconciling medications.  Through the medication reconciliation process, pharmacists can assess the completeness and accuracy of medication lists to reduce MEs and prevent those errors from affecting patients.



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Original Research Articles