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Pharmacy Practice (Granada)

On-line version ISSN 1886-3655Print version ISSN 1885-642X


DEEP, Louise et al. Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students. Pharmacy Pract (Granada) [online]. 2021, vol.19, n.3, 2471.  Epub Sep 27, 2021. ISSN 1886-3655.


Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution.


To evaluate the number and type of medication discrepancies identified by pharmacy students.


Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies.


There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system.


Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.

Keywords : Medication Reconciliation; Students, Pharmacy; Professional Competence; Pharmaceutical Services; Medical History Taking; Hospitalization; Pharmacists; Workforce; Cross-Sectional Studies; Australia.

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