Objective:Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians’ in obtaining medication histories by performing medication reconciliation and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients.Methods:This observational study was conducted over a 7 week period in the geriatric ward at Odense University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients’ admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric Department.Findings:In total, 629 discrepancies were detected during the conducted medication reconciliations, in average 3 for each patient. About 45% of the prescribing discrepancies were accepted and corrected by the physicians. “Medication omission” was the most frequently detected discrepancy (46% of total). During the prescribing reviews, a total of 860 prescription errors were detected, approximately one per medication review. Almost all of the detected prescription errors were later accepted and/or corrected by the physicians. “Dosage and time interval errors” were the most frequently detected error (48% of total). The time used by nurses for administration of medicines was reduced in the study period.Conclusion:This study suggests that pharmacy technicians can contribute to a substantial reduction in medication discrepancies in acutely admitted patients by performing medication reconciliation and focused medication reviews. Further randomized, controlled studies including a larger number of patients are required to elucidate whether these observations are of significance and of importance for securing patient safety.

Aims Drug‐related problems are a common complication in the transition from hospital to primary care and are associated with morbidity and increased health care costs. In this study, we evaluated the cost and consequences of a comprehensive pharmaceutical intervention compared with usual care, comprised of a medication review and patient interview before discharge and follow‐up for polypharmacy patients. Methods This economic evaluation was embedded within a randomized clinical trial. Patients were randomized to either the basic intervention group (n = 493) which received a medication review, the extended intervention group (n = 476) which received a medication review, discharge interview, and follow‐up, or the control group (n = 498) which received standard care. Total health care costs were estimated over a period of 180 days at individual patient level from a health sector perspective. Results The mean cost per patient was lower in the intervention groups (basic, €16 748; extended, €15 631) compared with the control group (€17 288), although these differences did not reach statistical significance. The costs of additional time used on medication reviews, patient interviews, and follow‐ups (€88) were outweighed by a decrease in costs of readmissions. The results of the clinical study favored the extended intervention group on clinical outcomes, with statistical significance on a composite of readmissions or emergency department visits within 180 days after inclusion (hazard ratio 0.77, 95% confidence interval 0.64‐0.93). Conclusions This comprehensive pharmaceutical intervention was not costly and positive effects were seen in the clinical outcomes, thereby reaching a decrease in total cost per patient on average. The results thus indicate that the intervention is cost‐effective and that the positive net effects can justify costs of the intervention.