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BRYAN AYES, PHARM.D., is Clinical Toxicology Fellow, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore; at the time of this study he was Pharmacy Practice Resident, Department of Pharmacy, UMass Memorial Medical Center (MMC), Worcester, MA. JENNIFER L. DONOVAN, PHARM.D., is Director, Cardiology Pharmacy Practice Residency, and Clinical Pharmacy Specialist, Cardiology, UMass MMC, and Assistant Professor Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester. BRIAN S. SMITH, PHARMD.,. BCPS, is Director, Pharmacy Practice Residency, and Clinical Pharmacy Specialist, Critical Care, UMass MMC, and Assistant Professor of Graduate Nursing, University of Massachusetts Medical School (UMMS), Worcester. CHRISTIAN A. HARTMAN, PHARM.D., is Director, Informatics and Patient Safety Pharmacy Practice Residency, and Medication Safety Officer, UMass MMC, and Assistant Professor of Medicine, UMMS.

Address correspondence to Dr. Hayes at the Department of Pharmacy, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655 (bhayes{at}rx.umaryland.edu).

Purpose. The effect of pharmacist conducted medication reconciliation on compliance with a hospital’s medication reconciliation policy was studied. Methods. In this eight-week pilot study, one pharmacist worked in the emergency department (ED) to facilitate the safe and accurate transfer of medication histories for admitted patients. During the first four weeks, retrospective chart review was performed for 100 patients in March 2006 to determine the compliance rate to the hospital’s medication reconciliation policy (medication reconciliation completed for every patient using the hospital-approved form). Over the next four weeks, the same pharmacist prospectively obtained medication histories from consecutive patients in April 2006; these patients comprised the study group. The pharmacist completed the medication reconciliation form and identified and corrected all discrepancies. Unpaired t tests and Fisher’s exact test were used to determine significant differences between groups. Results. The hospital-approved medication form was used for 78% of patients in the control group (78 of 100) and 100% of patients in the study group (60 of 60). The mean ± S.D. number of errors per form was significantly higher in the control group than in the study group, and the percentage of forms containing at least one error was significantly higher in the control group (p = 0.001 for both comparisons). Allergy documentation was recorded for 62 patients in the study group versus all 60 in the study group (p = 0.001). Conclusion. Pharmacist-conducted medication reconciliation in the ED increased compliance to the institution‘s medication reconciliation policy for admitted patients. Pharmacist-acquired medication histories had significantly fewer errors in documentation and had more documentation of patient allergies. Index terms: Administration; Allergies; Compliance; Documentation; Errors, medication; Hospitals; Patient information; Pharmacists, hospital