Impact of clinical pharmacist-led medication reconciliation on therapeutic process

• Published in: Saudi Journal for Health Sciences 2021-05, Vol.10 (2), p.73-79
• Main Authors: Elamin, Maram, Ahmed, Kannan, Saeed, Osman, Yousif, Mirghani
• Format: Article
• Language: English
• Subjects: clinical pharmacist; medication discrepancies; medication reconciliation
• ISSN: 2278-0521; 2278-0521
• DOI: 10.4103/sjhs.sjhs_6_21

The role of clinical pharmacists in the medication reconciliation (MR) process has been limited in the literature. Medication discrepancies and drug-related problems are safety challenges for hospitalized patients and healthcare professionals. The MR process is a standard practical tool at different hospital settings to optimize the correct use of medicines. The aim of this review was to evaluate the role of clinical pharmacists in the implementation of MR process at different practice settings. A literature search of Google Scholar, PubMed, ScienceDirect, and ELSEVIER for "medication reconciliation" and "medication discrepancies" with "clinical pharmacist" from 2011 up to September 2020 was conducted. The search findings revealed that; clinical pharmacist is the most capable health care provider in implementation of MR process due to his vast experience in medication history taking and drug therapy management. Medication discrepancies that can result in serious discomfort or clinical impairment of patients can be prevented by a clinical pharmacist-led MR process. Studies confirmed that clinical pharmacist's interventions contribute substantially to the detection and resolution of medication discrepancies in hospitalized patients. Moreover, another estimated benefit of pharmacist-led MR was cost reduction for patients, families, and healthcare system. These findings highly recommend further inclusion of a clinical pharmacist in a team-based MR in different health settings.