Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service.

Ann Nickerson, Neil J. MacKinnon, Nancy Roberts, Lauza Saulnier

Research output: Contribution to journalArticlepeer-review

114 Scopus citations


Seamless care is the desirable continuity of care delivered to a patient in the healthcare system across the spectrum of caregivers and their environments. Medication Reconciliation is one component of seamless pharmaceutical care. A randomized controlled trial, carried out over nine months with a six-month follow-up period, investigated the impact of a pharmacist-directed seamless care service. Intervention patients admitted to one of two general medicine units were subjected to a comprehensive seamless care discharge process as they were discharged from a regional, academically affiliated hospital in Moncton, NB. The number, type and potential clinical impact of drug-therapy problems for seamless monitoring (DTPsm) and drug-therapy inconsistencies and omissions (DTIOs) in hospital discharge medications were measured. A total of 253 patients, with 134 patients in the intervention group and 119 in the control group, completed the study. An average of 3.59 DTPsm per intervention patient, with 72.1% of these being scored as having a significant or very significant clinical impact level, were communicated to community pharmacists. Ninety-nine DTIOs were identified and resolved in intervention patients before discharge. A retrospective medical chart review demonstrated that the intervention resolved almost all DTIOs. In conclusion, a pharmacist-directed seamless care service had a significant impact on drug-related clinical outcomes and processes of care.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalHealthcare quarterly (Toronto, Ont.)
Volume8 Spec No
StatePublished - 2005
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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