From: Differences in medication reconciliation interventions between six hospitals: a mixed method study
WHO | A | B | C | D | E | F |
Patient selection: | Non | Non | Non | Non | High risk patientsa | Exclusion UDSb |
Type of pharmacy team members involved: | Pharmaceutical consultant | Pharmacy technician + pharmacist check | Pharmacy technician + pharmacist check | Pharmacy technician + specialized pharmacy technician + pharmaceutical consultant | Specialized pharmacy technician + pharmaceutical consultant + pharmacist | Pharmacy technician |
 |  |  | Nurse | Nurse |  |  |
WHERE (location interview) | A | B | C | D | E | F |
Admission | ||||||
 | On the ward | Outpatient clinic (elective) | @ home (mail/phone) | Elective patients: @ home (mail/phone) | @ home (mail/phone) | Outpatient clinic (elective) |
 |  | On the ward | On the ward | On the ward | On the ward | On the ward |
Discharge | ||||||
 | On the ward | Outpatient pharmacyd | On the ward | Outpatient pharmacy | On the ward | Outpatient pharmacy |
 |  |  | Outpatient pharmacy |  | Outpatient pharmacy + @home by phone |  |
HOW (process) | A | B | C | D | E | F |
Admission | ||||||
Verification: Information collection | digital or paper-based pharmacy dispensing information and GP | Digital pharmacy dispensing information | Patient list, extra check high risk patientsc, lab results | Digital pharmacy dispensing information | digital or paper-based pharmacy dispensing information and GP | digital or paper-based pharmacy dispensing information |
Clarification: Optimisation medication | 8 focuspoints, generally discussed @ discharge | Thrombo-profylaxis, oral antidiabetics | see above: focus on renal function, pain meds | No extra checks | see discharge | no extra checks |
 | Substitution |  | No substitution |  | Substitution |  |
Suggested medication changes | implementation of medication changes after check with physician | implementation of medication changes by pharmacy without physician check | implementation of medication changes after check with physician | Only acutely based on prescriptions | discussion with doctor after medication review | Only acutely based on prescriptions |
Documentation | On electronic dispensing information from pharmacy and checklist (not visible for other healthcare professionals) | On checklist (not visible for other healthcare professionals) | On Checklist (not visible for other healthcare professionals) | ? not visible for other healthcare professionals | In EPD and on electronic dispensing information from pharmacy (partly available for other healthcare professionals) | Electronic pre-registration (elective patients) available for other healthcare professionals |
Discharge | ||||||
Optimisation (number of focuspoints) | 8 | 2 | 2 | 0 | 6e | 3 (surgical ward only) |
WHEN (timing activity) | A | B | C | D | E | F |
Admission | ||||||
Interview elective patients (moment) Discharge | Day admission | Day admission | Weeks before procedure by mail | Weeks before procedure | Weeks before procedure by phone | Weeks before procedure |
Interview will be performed | If discharge announced 24Â h beforehand | Only if patient passes by outpatient pharmacy | Always | Only if patient passes by outpatient pharmacy | If discharge announced 24Â h beforehand | Only if patient passes by outpatient pharmacy |