A Comparative Prospective Interventional Study Shows The Impact Of The Clinical Pharmacists' Role In The Emergency Department In Medication Reconciliation Upon Patients' Admission To Reduce The Medication Discrepancies.
Phase: NA
Conditions: Medication Reconcilitation Upon Hospital Admission
Sponsor: Alexandria University

The cover page
 
 
The study official title: 
 
A comparative prospective interventional study shows the impact of the clinical pharmacists’ 
role in the emergency department in medication reconciliation upon patients’ admission to 
reduce the medication discrepancies.
 
IRB number : 00012098
 
Date of the document: 
 
19/12/2019
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Title 
 
A comparative prospective interventional study shows the impact of the clinical pharmacists’ 
role in the emergency department in medication reconciliation upon patients’ admission to 
reduce the medication discrepancies.
 
Background:
 
Hospital admission is a process which carries a high risk of medication discrepancies. This 
usually occur due to lack of information about patients’ drug history.  So one of the important 
roles of the clinical pharmacists in the emergency department is medication reconciliation on 
admission to establish a complete medication history list .Many studies found that medication 
reconciliation will reduce medication errors and achieve significant clinical and economic 
outcomes.      
Aim of the study:
 
The aim of the study is to calculate the total number of medication discrepancies recorded 
by the clinical pharmacists after medication reconciliation, to classify these medication 
discrepancies using Medications at Transitions and Clinical Handoffs (MATCH) Toolkit 
for Medication Reconciliation, to calculate the proportion of  the patients detected with 
one or more medication discrepancies and to calculate the total number of  complete 
medication history lists established after the clinical pharmacists medication 
reconciliation.    
Patients and methods:
 
Approval of the medical ethics committee of Alexandria faculty of Medicine will be taken.
 
 .No informed consent will be taken as medication reconciliation is considered to be an essential 
role of clinical pharmacists upon patients’ admission.
 
It is comparative prospective interventional study during the period from 1 January 2020 to 29 
February 2020  in emergency department in Alexandria Main University Hospital.
 
-Three/ four well trained emergency clinical pharmacists will start medication reconciliation on 
admission during the morning and evening shifts.
 
 -A full diseases and preadmission medications history will be taken from the patients or the 
family through interviews, revising previous prescriptions and hospital records. 
 
- Preadmission medication history will include medications trade names, doses, frequency and 
rout of administration and treatment duration and also will include the consumption of vitamins 
or herbs.
 

-The detection of medication discrepancies will be done through a comparison between each 
patient drug history already presented in the profile and drug history taken by the clinical 
pharmacists. 
 
- Establishment of a complete medication history list in each patient profile and discuss it with 
the physicians to rearrange the treatment plan will be done.
 
 
 Inclusion criteria:
 
1- Patients with one or more chronic disease / drug.
 
Exclusion criteria:
 
Patients who cannot communicate or have no family members.
 
Outcomes:
 
1- to calculate the total number of medication discrepancies recorded by the clinical 
pharmacists after medication reconciliation,  
 
2- to classify the medication discrepancies using Medications at Transitions and Clinical 
Handoffs (MATCH) Toolkit for Medication Reconciliation.                   
 
 
3- to calculate the proportion of  the patients detected with one or more medication 
discrepancies  
 
 
4- to calculate the total number of  complete medication history lists established after the 
clinical pharmacists medication reconciliation.    
 
Results:
 
The results obtained in this study will be tabulated, correlated and statistically analyzed.  
 
DISCUSSION 
The results of this work will be analyzed and discussed in the view of the achievement of the 
aim, their significance and comparison with other studies carried out by other investigators. 

Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation 
Agency for Healthcare Research and Quality 
 
Category Description 
A 
No error, capacity to cause error 
B 
Error that did not reach the patient 
C 
Error that reached patient but unlikely to cause harm (omissions considered to reach patient) 
D 
Error that reached the patient and could have necessitated monitoring and/or intervention to preclude harm 
E 
Error that could have caused temporary harm 
F 
Error that could have caused temporary harm requiring initial or prolonged hospitalization 
G 
Error that could have resulted in permanent harm 
H 
Error that could have necessitated intervention to sustain life 
I 
Error that could have resulted in death 

 
 
References:
 
1- JOUR, Buckley Mitchell, Harinstein Lisa, Clark Kimberly, Smithburger Pamela, Eckhardt 
Douglas, Alexander Earnest et al . Impact of a Clinical Pharmacy Admission Medication 
Reconciliation Program on Medication Errors in "High-Risk" Patients. The Annals of 
pharmacotherapy 2013/10/15 VL  - 47 .DOI  - 10.1177/1060028013507428. 
2- Lombardi NF, Mendes AEM, Lucchetta RC, Reis WCT, Fávero MLD, Correr CJ. Analysis of 
the discrepancies identified during medication reconciliation on patient admission in cardiology 
units: a descriptive study. Rev. Latino-Am. Enfermagem. 2016;24:e2760. DOI: 
http://dx.doi.org/10.1590/1518-8345.0820.2760. 
 
3-Giannini O, Rizza N,Pironi M, et al. Prevalence,clinical relevance and predictive factors of 
medication discrepancies revealed by medication reconciliation at hospital admission: 
prospective study in a Swiss internal 
medicine ward. BMJ Open 2019;9:e026259. doi:10.1136/bmjopen-2018-026259. 
4- Liesbeth B. E. Bosma1,2,3* , Nicole G. M. Hunfeld3,4, Rogier A. M. Quax4,5, Edmé 
Meuwese3, Piet H. G. J. Melief6,Jasper van Bommel4,  et al. The effect of a medication 
reconciliation program in two intensive care units in theNetherlands: a prospective intervention 
study with a before and after design .Ann. Intensive Care (2018) 8:19 
https://doi.org/10.1186/s13613-018-0361-2