Background: Pharmacists and pharmacy technicians have an opportunity to impact the quality of the medication histories and improve patient safety by ensuring accurate medication lists are obtained and complete reconciliation has occurred with the admission medication orders by owning the admission medication reconciliation process. Objective: To compare the quality of a pharmacy-based medication reconciliation program on admission utilizing pharmacists and technicians to the usual multidisciplinary process. Methods: This was a retrospective chart review process improvement study at a 186-bed tertiary care inpatient facility. Primary outcomes included both the accuracy of pre-admission medications listed and the reconciliation of those medications with admission inpatient orders. Technicians obtained patient medication histories. Pharmacists checked the technician-obtained medication histories and ensured reconciliation of those medications with admission orders. Results: Medication accuracy increased from 45.8% to 95% per patient (P , .001) and medication reconciliation increased from 44.2% to 92.8% (P , .001) and remained above benchmark. Conclusion: A pharmacy-based medication reconciliation program utilizing both pharmacists and technicians significantly increased the accuracy and reconciliation of medications on admission. These gains were maintained for the duration of the 6-month period studied and beyond per continued process improvement data collection.

Purpose: In the last few years, The Joint Commission (TJC) has strongly recommended that hospitals provide 24-hour pharmacy services. Many small to medium sized hospitals have insufficient workload and/or lack the financial resources to justify 24-hour pharmacy services. When a pharmacy does not provide 24-hour pharmacy services, it must provide a retrospective review of medication orders. Carolinas Healthcare System (CHS) faced the challenge of economically providing 24-hour pharmaceutical care in smaller to medium size hospitals by developing a remote order entry service (ROES). Summary: This article describes the process of implementing an ROES and the technology that is involved, including physician order transmittal, pharmacy information systems, communication between facilities, distribution of pharmaceuticals, and clinical pharmacy services. The financial and pharmaceutical service benefits are illustrated. Conclusion: ROES has proven to be an effective method that allows small to medium sized hospitals access to 24-hour pharmaceutical care in a fiscally responsible manner.