Evaluating and Improving Medication Reconciliation Processes at Hospital Admission in South East Nigeria

Medication discrepancies at hospital admission represent a preventable patient safety risk that can be substantially reduced through structured pharmacist-led medication reconciliation. This study evaluated existing medication reconciliation processes and developed an improvement framework for hospitals in the South East geopolitical zone. A multi-site prospective evaluation was conducted at three teaching and secondary hospitals in Anambra and Imo States. Admission medication histories were taken by pharmacists for 160 patients and compared with physician-obtained histories and admission prescriptions. Discrepancy rates, types, and clinical significance were documented. Current reconciliation policies were reviewed and staff knowledge assessed. A gap analysis was conducted to identify barriers and enablers. Results showed an unintentional discrepancy rate of 53.1 percent in standard physician-obtained histories, reduced to 14.4 percent when pharmacist reconciliation was applied. Drug omissions accounted for 61.5 percent of discrepancies, with antihypertensives, oral hypoglycaemics, and statins most frequently omitted. The improvement framework proposed includes a structured best possible medication history protocol, electronic medication list integration, designated pharmacy reconciliation hours, and a quality indicator dashboard for monitoring reconciliation completion rates. Staff training modules and a reconciliation documentation form are included as implementation tools. The study recommends adoption of this framework across all teaching hospitals in South East Nigeria and implementation of mandatory reconciliation for patients with five or more chronic medications.

Keywords: medication reconciliation, discrepancies, patient safety, South East Nigeria, pharmaceutical care