Communication between community and hospital pharmacists: impact on medication reconciliation at admission.

Objective: To evaluate the non-intentional prescription discrepancies between home medication and hospital medication for in-patients, their potential clinical impact and the impact of pharmaceutical communication between community pharmacists (CP) and hospital clinical pharmacists (HCP) to prevent them.

Setting: Prospective study of 278 in-patient's files hospitalized in orthopaedic surgery + units.

Methods: After reconciliation by the HCP including patient interviews, GP prescription reviews and CP drug delivery analyses, we analysed patient files (prescription and patient chart) and we compared the administered drugs (home medication) to those that the patient should have received.