4CPS-242 Effectiveness of pharmacist based medication reconciliation on patient safety

<h3>Background and Importance</h3> Discrepancies and medication errors are one of the most important challenges in the hospital which mostly occurs during the admission, discharge or transfer between wards. Medication reconciliation (MR) is a process to ensure the accurate and continuous transfer of information related to the patient’s medications at the time of hospital admission, transfer or discharge. <h3>Aim and Objectives</h3> The purpose of this study is to investigate the effectiveness of drug reconciliation on reducing medication errors and increasing patient safety. <h3>Material and Methods</h3> A retrospective study was conducted from December 2021 through October 2024. MR in our hospital consists of several steps. First, taking the best possible medication history from the patient at the time of admission and then comparing with the drugs prescribed in the hospital and checking the discrepancies. Preparing a comprehensive list of the patient’s medications at the time of discharge and teaching the patient about the medication regimen. Also when any intervention for dose adjustment, drug interaction, contraindications or adverse reaction is needed, the clinical pharmacist discuss the issue with practitioners and advises them. And finally, the pharmacist records all observed error and discrepancies in a form called Drug Related Problem (DRP). <h3>Results</h3> We did more than 26,200 admission and discharge MR in this period of time. In addition, more than 13,000 DRPs were registered. The number of medication discrepancies recorded was identified. The most prevalent medication error was made by the doctor and then the nurse. Medication errors leading to medication interactions were also common. <h3>Conclusion and Relevance</h3> In our country, our center is the first hospital that officially and seriously started drug reconciliation. Conducting a structured MR by pharmacist can prevent many medication errors and improve the patient9s outcome. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest