Evaluation of the Impact of Medication Reconciliation on Medication Discrepancies at a Hospital in Kogi State

Medication reconciliation is a structured process that reduces medication discrepancies at care transitions and prevents adverse drug events. This study evaluated the impact of pharmacist-led medication reconciliation on admission medication discrepancies at a general hospital in Lokoja, Kogi State, North Central Nigeria. A quasi-experimental pre-and-post study design was employed. In the pre-intervention phase, standard admission procedures were observed for 100 patients. In the post-intervention phase, pharmacist-led medication reconciliation was implemented for 100 consecutive admissions, involving medication history-taking, comparison with admission prescriptions, and identification of discrepancies. Discrepancies were categorised as omissions, commissions, or dose variations. Results showed a statistically significant reduction in medication discrepancies following pharmacist-led reconciliation. Pre-intervention, medication discrepancies were identified in 64.0 percent of admissions, compared to 23.0 percent post-intervention (p < 0.001). Drug omissions were the most common discrepancy type in both phases. The most frequently involved drug classes in discrepancies included antihypertensives, oral hypoglycaemics, and cardiovascular agents. Prescriber acceptance of pharmacist reconciliation recommendations was 88.0 percent. The study concludes that pharmacist-led medication reconciliation substantially reduces discrepancies at hospital admission in this setting and recommends mandatory reconciliation programmes at admission, discharge, and inter-unit transfer for all patients on five or more medications. Keywords: medication reconciliation, discrepancies, transitions of care, Kogi State, clinical pharmacist