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P.Rama*, G. Rajendiran, T. A. Angel, Dennies Daniel, R. K. Nandhini and S. Poornima Devi


Medical reconciliation is done to avoid medication discrepancies. It should be done at all transitions of care in which new medications are ordered or existing orders are rewritten. Cardiology patients have greater chances of getting medication discrepancies. The goal of this study is to bring out a rational prescribing pattern during transitions of care and to reduce medication errors, adverse drug events, drug interactions, treatment costs, drug related problems which lead to re- hospitalization.This was a prospective interventional study conducted in cardiology department of a tertiary care hospital with historical control. In control group, chart review was performed to identify drug related problems (DRPs). In test group, best possible medication history (BPMH) was taken within 48 hours of admission and medical reconciliation was done to identify drug related problems. These drug related problems were classified according to Pharmaceutical Care Network Europe Foundation (PCNE) Version 6.2. The most commonly identified problems were untreated indication, non-allergic adverse drug event, unnecessary drug treatment and drug interactions which were caused by drug selection, inappropriate timing of administration and prescribing error. Factors associated with occurrence of DRPs include middle age, administering more than 10 drugs and in-hospital stay. Some of these DRPs were brought to the notice of the prescribers and eventually solved. Thus, the involvement of clinical pharmacist in conducting medical reconciliation will help ameliorate drug related discrepancies in transitions of care.

Keywords: Medical reconciliation, Drug related problems, Cardiology, PCNE V6.2.

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