Implementation of a Pharmacist-Led Medication Reconciliation Protocol for Post- Hospitalized Patients in a Rural Midwest Clinic

Introduction: Medication reconciliation is an important part of medication safety among post-hospitalized patients. Medication reconciliation is the review of patients’ home medications with the patients’ electronic health record. Medication discrepancies result in adverse health outcomes. Pharmacists are experts in medication review and therefore may help avoid these occurrences. Methods: The aim of this review was to determine the benefit of pharmacist-led medication reconciliation in a primary care setting. Four databases were searched using inclusion and exclusion criteria and from this search, 12 articles were reviewed. Current barriers such as lack of time and availability may inhibit pharmacist-led medication reconciliation in current practice. Gaps: There are current gaps in the literature for care transitions to primary care, even though multiple medication errors happen at transition from hospital to home. Rural healthcare settings are at an even higher disadvantage, and research is lacking in these settings. Recommendations for Practice: A multidisciplinary approach to medication reconciliation in care transitions may be necessary to reduce medication errors resulting in adverse drug events. More evidence is needed to determine the effectiveness of medication reconciliation in primary care settings