Abstract

This preliminary study was conducted to identify the types and frequency of medication discrepancies, and clinical pharmacists' interventions made upon patients' admission. Medication Reconciliation (MR) was done by clinical pharmacists routinely on inpatients from intensive care unit, medical and surgical wards at Al Wakra hospital. This retrospective study was conducted on 251 MR forms used by the clinical pharmacists. Data analysis was carried out using SPSS version 21.0. Kolmogorov‐Smirnov test was done to confirm for normality. Chi-Square, Spearman rho and Mann-Whitney U tests were carried out at alpha = 0.05. Out of the 251 forms, 232 were usable. 1640 medications were reconciled. The number of medicines reconciled ranged from 1 to 17. The majority of the medications reconciled were cardiovascular medications (n = 144; 62.2%). The highest number of medicines discrepancies were 2 with 39 cases (16.7%) and mostly were due to medication omissions (n = 153; 66.1%). Clinical pharmacists intervened the highest for omitted medications that required resumption (n = 111 of the cases; 44%). There was a significant correlation between the percentage of discrepancies and the number of clinical pharmacists' interventions (p < 0.01). Gender is not a factor for number of medication discrepancies (p = 0.157) and the rate of omission (p = 0.281). Medication discrepancies upon hospital admission are highly common. The highest number of medicines discrepancies was two and mostly were due to medication omissions.

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