| The NTUH-IMM model | Usual care |
---|---|---|
Pharmacist integrated into the medical team | ||
Clinical pharmacists participated in the daily ward round | Yes | No |
Clinical pharmacists stay on the ward to provide services | Yes | No |
Communication between pharmacists and other healthcare professionals | Mainly face-to-face | Mainly by telephone or text messages |
Medication reconciliation during admission | ||
Medication history documentation | •The central pharmacy pharmacist interviews the patients or caregivers to collect medication history •Medication history was further verified with data from the PharmaCloud system •Best possible medication history was documented on the EMRa system with the details of using-pattern | •The nurse practitioner interviews the patients or caregivers to collect the medication history •Medication history was not verified •Medication history was documented on the EMR system without details |
Reconciliation | •The clinical pharmacist and the central pharmacy pharmacist discuss the patients’ medication history •If medication discrepancy exists, the clinical pharmacist reconciles it according to the patient’s condition | •The pharmacists are not required to perform medication reconciliation routinely •There is no standard process for pharmacists to perform medication reconciliation |
Medication review during hospitalization | ||
Data resource | •The best possible medication history •Direct observe the patients •EMR system •Information from other healthcare professionals | •EMR system |
Decision making | •The clinical pharmacist discusses the regimens with other healthcare professionals and make a decision collaboratively | •The central pharmacy pharmacist makes suggestions to healthcare professionals without comprehensive discussion |