SERIOUS Medication Reconciliation Clinic: Improving Transitions of Care

Clinical Pharmacy Services in Heart Failure: An Opinion Paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network

“…Complex medical regimens for HF and other comorbidities increase the likelihood for medication reconciliation discrepancies. Numerous studies have found that pharmacists significantly reduce medication errors and improve patients' knowledge retention at the time of admission, discharge, and post‐hospitalization follow‐up when they are involved in medication reconciliation . Pharmacists involved in a multidisciplinary postdischarge HF medication reconciliation clinic found that 52% of patients had at least one medication discrepancy from the prescribed discharge regimen at the follow‐up visit, despite the majority receiving discharge counseling during the hospitalization …”

“…It may be related to inadequate patient education, poor retention of information provided during hospitalization, cognitive impairment, economic barriers, lack of adequate social support, and poor health literacy. Studies have shown that pharmacist interventions such as discharge counseling or home‐based education to improve adherence and optimize medications result in a reduction in hospitalizations . A primary focus of clinical pharmacy services is identifying barriers to medication adherence or access (e.g., affordability of medications) and finding ways they can be addressed.…”

Role of the Ghanaian Clinical Pharmacist in Providing Evidence-based Pharmacotherapy for Heart Failure Patients: The Way Forward

“…Complex medication regimens for heart failure coupled with other comorbidies increase the likelihood of medication reconciliation discrepancies. Clinical Pharmacists leading the medication reconciliation process, perform medication reviews, communicate prescribing errors with the cardiologist, prepare written overviews of discharge medications and communicate with community pharmacists and patients primary care physicians about their medications in order to establish continuum of care so as to significantly reduce medication discrepancies [30][31][32][33][34][35][36][37][38][39][40].…”

Clinical Pharmacy Services in Heart Failure: An Opinion Paper From the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network

“…Numerous studies have found that pharmacists significantly reduce medication errors and improve patients' knowledge retention at the time of admission, discharge, and post-hospitalization follow-up when they are involved in medication reconciliation. [45][46][47][48][49][50][51][52][53][54][55][56] Pharmacists involved in a multidisciplinary postdischarge HF medication reconciliation clinic found that 52% of patients had at least one medication discrepancy from the prescribed discharge regimen at the follow-up visit, despite the majority receiving discharge counseling during the hospitalization. 54…”

“…[45][46][47][48][49][50][51][52][53][54][55][56] Pharmacists involved in a multidisciplinary postdischarge HF medication reconciliation clinic found that 52% of patients had at least one medication discrepancy from the prescribed discharge regimen at the follow-up visit, despite the majority receiving discharge counseling during the hospitalization. 54…”