28. Pharmacists Preventing Medication Mix‑Ups from Melbourne

Transitions of care from hospital to home are some of the riskiest moments in a person’s healthcare journey. Medication lists change, high‑risk medications require careful monitoring, and patients often deal with overwhelming amounts of instructions. Linda Graudins tells us how pharmacists play crucial roles in helping people on complex medication regimens navigate these challenges safely. We’ll look at a process called medication reconciliation which is a bit like medication detective work and helps pharmacists keep those potentially dangerous transitions from home to hospital, and back to your home, smooth and safe.References:Agency for Healthcare Research and Quality. Medication Reconciliation. Patient Safety Network (PSNet). Published September 2019. Updated December 15, 2024.McNab D, Bowie P, Ross A, MacWalter G, Ryan M, Morrison J. Systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge. BMJ Qual Saf. 2018;27(4):308–320. doi:10.1136/bmjqs-2017-007087.International Pharmaceutical Federation (FIP). Medicines reconciliation: A toolkit for pharmacists. The Hague: International Pharmaceutical Federation; 2021.Cheema E, Alhomoud FK, Kinsara ASAL-D, et al. The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE. 2018;13(3):e0193510. doi:10.1371/journal.pone.0193510.Patel E, Pevnick JM, Kennelty KA. Pharmacists and medication reconciliation: a review of recent literature. Integr Pharm Res Pract. 2019;8:39–45. doi:10.2147/IPRP.S154388.Schnipper JL. Medication reconciliation—too much or not enough? JAMA Netw Open. 2021;4(9):e2125272. doi:10.1001/jamanetworkopen.2021.25272.