Data collection and outcomes
The demographic characteristics, clinical characteristics and hospitalization records were collected. We used a standardized medication reconciliation form to collect the sources used and the types and the numbers of discrepancies for each reconciliation procedure. The reconciliation team documented the time of data collection and completing the form. The drugs were classified according to WHO Anatomical Therapeutic Classification (ATC)[20].
The primary outcome of the study was the type, the frequency and the associated risk factors of UMDs. The potential risk factors assessed were as follows: age, sex, type of medical specialty, educational status, living status, the number of drugs taken prior to admission, the admitting physician’s experience (intern, resident or attending doctor), the day of admission (working days, weekends and holidays), the type of admission (planned or unplanned), and patient’s understanding of preadmission medications. The secondary outcome was to evaluate the potential harms of errors prevented by pharmacist intervention. Resources required to support the medication history and reconciliation process were also evaluated.