Jessica Conklin|John Togami|Allison Burnett|Melanie Dodd|Gretchen Ray
Care Transitions Service: A pharmacy-driven program for medication reconciliation through the continuum of care
University of New Mexico|University of New Mexico Hospital|University of New Mexico Hospital
qualityimprovement program university new mexico hospital unmh encompassing admission discharge postdischarge medication reconciliation activities described report initial assessments programs impact rates medicationrelated problems mrpspharmacists conducted fivemonth evaluation unmh care transitions service cts serves inpatients admitted hospitals family medicine service providing medication reconciliation targeted mrp interventions selected patients received cts services november 2012 march 2013 n 191 included analysis study endpoints rates types mrps identified commonly implicated medication classes predictors mrps postdischarge mrp rates twomonth trial cts services unmh outpatient clinic also evaluatedduring fivemonth evaluation inpatient cts services total 1140 mrps identified average 6 per patient 70 resolved independently provider review using pharmacydriven protocols twomonth pilot test cts outpatient services n 16 total 28 mrps identified 80 cases decline number mrps admission postdischarge medication reconciliationmrps identified continuum care majority mrps identified inpatient outpatient settings involved patient variables patient nonadherence seventy percent inpatient mrps resolved independently cts team pharmacydriven protocols