No big surprise here. An study that used pharmacists to “[provide] perspectives on admission and discharge medication reconciliation, in-hospital patient counseling, provision of simple medication adherence aids (eg, pill box, illustrated daily medication schedule), and telephone follow-up” found that ”pharmacists are well positioned to participate in hospital-based medication reconciliation, identify patients with poor medication understanding or adherence, and provide tailored patient counseling to improve transitions of care“. Makes sense, don’t you think? After all, that’s what pharmacist do. They deal with medications. All things to do with medications, which includes medication reconciliation.
When I was in pharmacy school at UCSF fourth year pharmacy students were responsible for medication reconciliation. Each “general medicine” team had a fourth year pharmacy student on it, and when there was a new admission the student would interview the patient and reconcile their medication lists. Then we’d simply place the reconciled list in the chart for the attending. When it was time for discharge we’d do it all over again. Often times we’d go as far as to get the discharge prescriptions filled at the outpatient pharmacy and deliver them to the patient bedside where we would provide consultation and education before the patient went home. Pretty cool stuff. This is how it should be done at every hospital. Just sayin’.