To Evaluate the Role of Pharmacist in Medication Reconciliation on Discharge Patients in A Primary Hospital: An Observational Study

Objectives: The aim of this study was to assess the frequency and characteristics of discharge medication discrepancies and medication errors as identified during discharge with medication reconciliation. Methods: From June 2024 to January 2025, a prospective study was performed at Damak hospital in general medicine department, a primary care hospital in Damak, Jhapa. The information from discharge prescriptions as compared to the medication administration record (MAR), medication history taken at the time of admission was analyzed by the pharmacist before discharge. Results: Pharmacists performed 504 discharge medication reviews 65.47% (330 patients) had discrepancies in their prescriptions. 24.84% of patient lies in (18-39yrs). Notably, 38.48% of the patients were aged above 60, emphasizing the vulnerability of geriatric individuals for developing chronic diseases. The presence of polypharmacy is a key factor in the occurrence of medication discrepancies. Among the 504 patients in the study, 283(56.15%) patients has polypharmacy condition more than five drugs in a prescription and 221(43.85%) patients has less than 5 drugs. Out of the 330 discrepancies identified during discharge, 56.07% (185 discrepancies) were intentional, and 43.93% (145 discrepancies) were unintentional. The majority of patients (43.63%) had two comorbid conditions, followed by those with one comorbidity (29.09%). Conclusion: Lack of medication reconciliation can cause significant medication errors, which might be serious and cause harm to patients. This study has the potential to shape policies and practices that prioritize medication safety and optimize patient outcomes during transitions of care.Our study also aids in improving the safe and effective use of drugs in our hospital. Our study also helped to define the significant role of the pharmacist in assessing and controlling medication errors.