الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
A strategy for patient safety that has been declared problematic is the medication reconciliation process. It is a vital tool for minimizing medication errors and prevent patient harm. Medication reconciliation is defined by WHO as the official process in which healthcare professionals collaborate with patients to guarantee accurate and comprehensive medical information transfer during patient’s transfer of care. As stated by WHO, there are four different steps of the medication reconciliation process; creating the best possible medical history, verify the accuracy of the medical history, reconciliation of the BPMH with the prescribed medication and finally provide precise medication information. Medication reconciliation process should be a procedure that requires teamwork of the healthcare professionals utilizing the expertise and time of different healthcare professionals. There must be continuous cooperation between the team members. Medication reconciliation is not just a hypothetical process, it requires an effective strategy to guarantee adequate knowledge and effective education for the healthcare team and good implementation plan. It requires clarity of roles and responsibilities and good communication and leadership support.
The objective of the study:
This study aimed to assess the knowledge, perception and practice of physicians and pharmacists towards medication reconciliation at Mery hospital, the main university hospital in Alexandria.
Material and Methods:
This study was a descriptive, cross-sectional design. Residents and pharmacists working in the main university hospital in Alexandria were eligible to take part in the research. A total number of 386 physicians and pharmacists agreed to participate in the study. Using a predesigned self-administered questionnaire. Data was collected between the period of November 2021 to August 2022.
The Data collection and tools:
Data was collected between the period of November 2021 to August 2022, using a predesigned self-administered questionnaire composed of four sections. The first section collected socio-demographic data (age, gender, basic graduation, years of experience and post graduate studies). The second section assessed the knowledge and awareness of medication reconciliation process. The third section assessed the perception of physicians and pharmacists about medication reconciliation process. The fourth section assessed the existing practice of medication reconciliation process.
Results:
Overall, a higher percentage of participating physicians and pharmacists (60.9%) was not familiar with the term “medication reconciliation”. Significantly higher percentage of pharmacists (58.7%) was familiar with “medication reconciliation” term. While significantly higher percentage of physicians (70.4%) was not familiar with “medication reconciliation” term. Significantly highest percentage of participating Physicians and pharmacists (79%) was unaware of the steps of medication reconciliation process. There was significant contradiction between perception of physicians and pharmacists regarding the responsibility of medication reconciliation process. As highest percentage of physicians reported that it is their role (66.5%) to reconcile medications between the history and admission orders, followed by pharmacists’ role (32.3%). On other hand, the highest percentage of pharmacists reported that it is their role (73%), followed by physicians’ role (32.5%).
6.2 Conclusion
In perspective with the results of the current study, the following may be concluded:
1. The highest percentages of the participating physicians and pharmacists were aged from 25 to 30 years old and females.
2. Higher percentages of participating physicians had less than 5 years of work experience and didn’t receive post graduate studies while higher percentages of participating pharmacists had more than 10 years of work experience and received post graduate studies.
3. About half of the physicians and pharmacists didn’t know whether the hospital was accredited by GAHAR. And a higher percentage of pharmacists were significantly familiar with medication reconciliation in contrast to physicians.
4. The main source of awareness about medication reconciliation for pharmacists was “post graduate studies” While “university education” was the main source for physicians.
5. Higher percentages of physicians and pharmacists didn’t acquire education or training during pursuing university degree and didn’t attend official education or training at workplace regarding their roles in medication reconciliation process.
6. A higher percentage of physicians and pharmacists reported that they were not aware of steps of medication reconciliation.
7. Regarding the perception of physicians and pharmacists about the responsibility for each step of medication reconciliation process, both physicians and pharmacists significantly agreed that the physicians were responsible for collecting an initial medical history and assuring medical history is accurate.
8. There was significant contradiction between physicians’ and pharmacists’ perceptions regarding the primary responsibility for reconciling medications between the history and admission orders as the highest percentage of physicians reported that it is their role. while the highest percentage of pharmacists reported that it is the pharmacist’s role.
9. There was significant contradiction between physicians’ and pharmacists’ perceptions regarding the primary responsibility for the remaining steps of medication reconciliation (transfer of a patient to another level, reconciling medication at the time of discharge, sending the patient’s discharge medication list to the next provider).
10. The greatest proportions of physicians and pharmacists perceived the value of medication reconciliation process to patient safety as most of them agreed about pharmacists’ involvement in transition of care activities, assessing the appropriateness of medication, prevention and solving medication related problems, minimizing medication errors. Moreover, most physicians and pharmacists agreed that medication reconciliation should be provided to all patients and that it leads to reduction in patient harm.
11. Greatest proportion of physicians and pharmacists perceived that “teamwork among disciplines”, “centralized patient medication history files” and “the awareness of the role of each contributor” were among the most important success factors for medication reconciliation process. while greatest proportion considered “unreliable patient as no record or unaware of their medications”, “difficulty to obtain documentation from other sources”, “lack of information provided by healthcare professionals who first see the patient” and “lack of physician collaboration after receiving the complete medication list” from the most important significant barriers of the medication reconciliation.
12. A nearly equal percentage of physicians and pharmacists reported there is absence of standardized procedure for medication reconciliation in the hospital.
13. The greatest proportions of physicians and pharmacists reported non implementation of policy regarding the onset of start reconciliation process after obtaining medication history. Moreover, higher percentages significantly reported lack of knowledge about hospital policy that specify a different time frame for reconciliation depending upon the critical nature of the drugs on medical history list and lack of knowledge about type of form used for documentation and whether the medications was order directly on the same form used to document the initial medical history.
14. Regarding medication reconciliation discharge process, significantly higher percentage of physicians and pharmacists stated absence of electronic connectivity in hospital in order to obtain a list of patient medication, presence of handwritten lists of current medication to patients when they are discharged and absence of computer-generated lists.
6.3 Recommendations:
The study’s conclusions and findings justify consideration of the following recommendations:
1. Awareness about medication reconciliation among healthcare providers should be raised by attending dedicated formal training, workshops, and educational programs regarding medication reconciliation steps and responsibilities. The educational programs should be continuous and ongoing. In addition, these workshops should address teamwork, communication, and administrative leadership.
2. Directors and managers of university hospitals should address the barriers against implementation of medication reconciliation.
3. A standardized medication reconciliation policy should be implemented. Every department in the hospital should have its own medication reconciliation procedures to be guideline for implementing medication reconciliation process in the most easy and applicable possible way such as: the specific time frame for medication reconciliation, dealing with critical nature drugs.
4. Documentation and reporting system of medication reconciliation should be standardized. Electronic connectivity and communication technology should be provided to ease and facilitate the documentation of medication reconciliation process and obtaining patient’s medical history.