Impact of team-versus ward-aligned clinical pharmacy on unintentional medication discrepancies at admission.

Background Medication reconciliation at admission to hospital reduces the prevalence of medication errors. Strategies are needed to ensure timely and efficient delivery of this service. Objective To investigate the effect of aligning clinical pharmacy services with consultant teams, by pharmacists attending post-admission ward rounds, in comparison to a ward-based service, on prevalence of unintentional unresolved discrepancies 48 h into admission.

Clinical pharmacist's contribution to medication reconciliation on admission to hospital in Ireland.

Background: Medication reconciliation has been mandated by the Irish government at transfer of care. Research is needed to determine the contribution of clinical pharmacists to the process.

Objective: To describe the contribution of emergency department based clinical pharmacists to admission medication reconciliation in Ireland.

Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.

Aims: Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation.