Hospital Pharmacy最新文献

{"title":"Safety and Efficacy of Switching Patients With Type 2 Diabetes From Glucagon-Like Peptide-1 Receptor Agonists to Tirzepatide: A Case Series.","authors":"Sami Barakat, Shannon Ramdeen, Rebecca Khaimova","doi":"10.1177/00185787241266803","DOIUrl":"https://doi.org/10.1177/00185787241266803","url":null,"abstract":"<p><p><b>Background:</b> Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist (RA) that is approved for the treatment of type 2 diabetes mellitus (T2D). Despite its similarities to GLP-1 RA, there is a lack of data on how to switch between GLP-1 RA and GIP/GLP-1 RA. <b>Objectives:</b> The objective of this study is to evaluate the efficacy and safety of switching from GLP-1 RA to tirzepatide in patients with T2D and provide guidance for switching between the two classes. <b>Methods:</b> This was a retrospective case series of patients with T2D who met protocol criteria for switching between the two classes. Hemoglobin A1C (A1C) and weight data were evaluated at 3 and 6 months. <b>Results:</b> A total of 10 patients were included. Mean change from baseline in A1C was -0.7 ± 0.9% at 3 months (N = 8) compared to -1.4 ± 0.7% at 6 months (N = 4). Percentage of patients who achieved their goal A1C was 25% (2/8) at 3 months post switch compared to 50% (2/4) at 6 months. Mean change from baseline in weight was -3.6 ± 2.3 kg at 3 months and -6 ± 3.4 kg at 6 months. Percentage of patients who achieved weight loss from baseline of ≥10% was 0 at 3 months versus 33.3% (1/3) at 6 months. Few adverse events were reported after switching. <b>Conclusion:</b> Switching can be considered for patients with T2D that require further A1C and weight reduction to reach their target goals despite being on GLP-1 RA.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"614-619"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Stress Ulcer Prophylaxis Deprescribing in Children Receiving Usual versus High-Dose Corticosteroids in the Pediatric Intensive Care Unit with Status Asthmaticus.","authors":"Avery Parman, Jamie L Miller, Stephen Neely, Peter N Johnson, Neha Gupta","doi":"10.1177/00185787241267723","DOIUrl":"10.1177/00185787241267723","url":null,"abstract":"<p><p><b>Purpose:</b> To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving \"usual-dose\" (<4 mg/kg/day methylprednisolone equivalents) versus \"high-dose\" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). <b>Methods:</b> This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups. Secondary objectives included a comparison of SUP-associated adverse events (ADEs) (pneumonia, <i>Clostridium difficile</i> colitis, thrombocytopenia, necrotizing enterocolitis) between groups. Comparisons were performed using exact <i>χ²</i> test or Wilcoxon <i>U</i>-tests as appropriate, with a <i>P</i> value <.05. <b>Results:</b> Ninety-six patients received usual-dose and 57 received high-dose corticosteroids. Eighteen (11.8%) patients were transferred within 24 hours of PICU admission and started on SUP on the floor. Thirteen (8.5%) patients were discharged home from the PICU. The remaining 122 (79.7%) patients were transferred from PICU to the floor and there was no statistical difference for continuation of SUP on the floor between usual-dose versus high-dose group, 58 (76.3%) versus 31 (67.4%) patients, <i>P</i> = .282. Overall, 25 of 153 (16.3%) patients were discharged home on SUP, but there was no difference between groups. SUP-associated ADEs did not differ between groups. <b>Conclusions:</b> SUP continuation during transitions of care in this cohort was common. Assessment of SUP continuation is needed during transitions of care to promote SUP stewardship and limit risk of SUP-associated ADEs.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"677-683"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Inpatient Pharmacist-Led Medication Reconciliations on Medication-Related Interventions in Intensive Care Unit Recovery Centers.","authors":"Sarah K Singer, Kevin D Betthauser, Alexandra E Barber, Rebecca Bookstaver Korona, Deepali Dixit, Christine M Groth, Michael T Kenes, Pamela MacTavish, Rachel M Kruer, Cara M McDaniel, Allyson M McIntire, Emily Miller, Rima A Mohammad, Janelle O Poyant, Stephen H Rappaport, Jessica A Whitten, Siu Yan A Yeung, Joanna L Stollings","doi":"10.1177/00185787241269113","DOIUrl":"10.1177/00185787241269113","url":null,"abstract":"<p><p><b>Background:</b> Critical care pharmacists complete comprehensive medication reviews in Post Intensive Care Syndrome (PICS) patients at Intensive Care Unit Recovery Centers (ICU-RCs) to optimize medication therapies after hospital discharge. Inpatient pharmacists often complete medication reconciliations prior to hospital discharge, which could affect interventions at an ICU-RC. However, this association remains ill-described. <b>Objective:</b> The purpose of this study was to, in patients with PICS, describe the effect of an inpatient, pharmacist-led medication reconciliation on the number of clinical pharmacist interventions at the first ICU-RC visit. <b>Methods:</b> This was a post-hoc subgroup analysis of an international, multicenter cohort study of adults who had a pharmacist-led comprehensive medication reconciliation conducted in 12 ICU-RCs. Only patients' first ICU-RC visit was eligible for inclusion. The primary outcome was the number of medication interventions made at initial ICU-RC visit in PICS patients who had an inpatient, pharmacist-led medication reconciliation compared to those who did not. <b>Results:</b> Of 323 patients included, 83 received inpatient medication reconciliations and 240 did not. No difference was observed in the median number of medication interventions between groups (2 vs 2, <i>p</i> = .06). However, a higher incidence of any intervention (86.3% vs 78.3%, <i>p</i> = .09) and dose adjustment (20.4% vs 9.6%; <i>p</i> = .03) was observed in the no medication reconciliation group. Only ICU Sequential Organ Failure Assessment score was associated with an increased odds of medication intervention at ICU-RC visit (aOR 1.15, 95% CI 1.05-1.25, <i>p</i> < .01). <b>Conclusion and Relevance:</b> No difference in the total number of medication interventions made by ICU-RC clinical pharmacists was observed in patients who received an inpatient, pharmacist-led medication reconciliation before hospital discharge compared to those who did not. Still, clinical observations within this study highlight the continued importance and study of clinical pharmacist involvement during transitions of care, including ICU-RC visits.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"650-659"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Research Into Practice as a Clinical Based New Practitioner Pharmacist.","authors":"Katy Stephens, Karen Abboud, Savanna Scott, Maggie Lau","doi":"10.1177/00185787241274784","DOIUrl":"https://doi.org/10.1177/00185787241274784","url":null,"abstract":"<p><p>Scholarly activities are essential for enhancing the pharmacy profession, as well as for personal career development. New practitioner pharmacists in academic or community medical center settings may hesitate to incorporate research into their practice if they feel that they do not have the appropriate resources and guidance. While residency provides structured support for research endeavors, new pharmacists may still find research activities daunting to initiate on their own. Many factors should be considered, including strategies for incorporating research into current roles, collaboration efforts, professional opportunities, and timeline considerations, to help pharmacists effectively implement research early in their careers. This article provides new practitioners with a roadmap to navigate challenges and achieve success when integrating scholarly activities into their practice.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"601-605"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Medication Reconciliation Improvement Package on Adherence to Medication Reconciliation Among Internal Medicine Physicians: A Quality Improvement Project in a Lower-Middle Income Country.","authors":"Saad Bin Zafar Mahmood, Fazal Rehman, Aisha Jamal, Naureen Ali Meghani, Madiha Iqbal, Ambreen Amirali, Aysha Almas","doi":"10.1177/00185787241253442","DOIUrl":"https://doi.org/10.1177/00185787241253442","url":null,"abstract":"<p><p><b>Background:</b> Medication reconciliation is one of the best measures to prevent medication-related errors at the time of admission and discharge of patients. We conducted a quasi-experimental study to evaluate the impact of a Medication reconciliation improvement package (intervention) on adherence to medication reconciliation at the time of admission in Department of Internal Medicine. The study included all adult patients admitted to internal medicine from August 2019 to December 2020. Pre-intervention data on adherence to medication reconciliation was less than 50%. The study involved creation of a quality improvement team to conduct a root-cause analysis which identified the need to target physician related issues and hence drafted a medication reconciliation improvement package which included meetings with physicians on the internal medicine floor, dedicated WhatsApp groups for repeated reminders, and appreciation messages for timely adherence. We used the Chi Square test to check the association between adherence to medication reconciliation and physicians and acuity level. <b>Findings:</b> We included 7914 records of patients, in which 4471 participants (56.4%) were from pre-intervention phase and 3443 (43.5%) were from intervention groups. The overall adherence to medication reconciliation was 54.3% (4297/7914). Adherence of medication reconciliation increased from 44.4% (1983/4471) in the pre-intervention phase to 67.2% (2314/3443) in the intervention phase (<i>P</i> < .001). Improvement was observed in adherence of medication reconciliation done by residents and in low acuity areas (<i>P</i> < .005). <b>Conclusion:</b> The Medical reconciliation improvement package is a simple low-cost intervention that resulted in improvement in adherence to medication reconciliation but needs further studies to assess its sustainability. However, it awaits to be seen if the same improvement can also be replicated to qualitative medication errors and clinical outcomes respectively.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"624-630"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of <i>TBXA2R</i> Gene Variants on the Risk of Aspirin-Induced Upper Gastrointestinal Bleeding: A Case-Control Study.","authors":"Marcela Forgerini, Ana Luísa Rodriguez Gini, Isabele Held Lemos, Ana Caroline Silva Santos, Maria Paula Bessa, Sandro Roberto Valentini, Patrícia de Carvalho Mastroianni","doi":"10.1177/00185787241269111","DOIUrl":"10.1177/00185787241269111","url":null,"abstract":"<p><p><b>Objective:</b> Upper gastrointestinal bleeding (UGIB) has been identified as a potential adverse drug reaction associated with the use of low-dose aspirin (LDA). This study aimed to investigate the relationship between variants in the <i>TBXA2R</i> gene, which is involved in platelet aggregation, and the risk of UGIB in patients with cardiovascular diseases treated with LDA. <b>Methods:</b> A case-control study was conducted at a Brazilian hospital complex. Three groups were defined: (1) case group (n = 50): patients with cardiovascular disease who used LDA and were diagnosed with UGIB of non-variceal etiology, (2) LDA control group (n = 50): patients with cardiovascular disease who used LDA without developing UGIB, and (3) healthy control group (n = 189). Data were collected through face-to-face interviews, and blood samples were collected for the analysis of <i>Helicobacter pylori</i> infection and genotyping of 3 genetic variants [rs2238631 (C > T), rs4807491 (A > G), and rs1131882 (A > G)]. <b>Results:</b> The case group had a significantly higher frequency of carriers of the rs4807491.G allele compared to the control group of LDA users (<i>P</i>-value = .004). No significant difference was observed in the proportion of carriers of the rs2238631.T and 1131882.G variants between the studied groups. Carriers of rs2238631.T (OR: 4.515, 95% CI: 1.37-14.89) and rs4807491.G allele (OR: 3.232, 95% CI: 1.12-9.37) exhibited a higher risk of UGIB. <b>Conclusion:</b> These findings suggest that the presence of the rs2238631 and rs4807491 variant alleles is associates with a 3- to 4-fold increased risk of UGIB in patients with cardiovascular diseases treated with LDA. Future studies with larger sample sizes should confirm these results and to better identify individuals who may benefit from chronic LDA use.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"666-676"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phytonadione Utilization and the Risk of Bleeding in Chronic Liver Disease.","authors":"Joanna He, Tessa R Cox, Brian W Gilbert","doi":"10.1177/00185787241269114","DOIUrl":"10.1177/00185787241269114","url":null,"abstract":"<p><p><b>Purpose:</b> To determine the safety and efficacy of phytonadione in patients with an elevated international normalized ratio (INR) secondary to chronic liver disease without active bleeding. <b>Methods:</b> This retrospective chart review compared hospitalized patients from 2015 to 2022 with a diagnosis of chronic liver disease, a baseline INR of 1.2 to 1.9, and without active bleeding who did or did not receive phytonadione. The primary outcome was the incidence of new bleeding. The incidence of thrombosis and change in INR were also evaluated. <b>Results:</b> A total of 133 patients were included, of which 46 received phytonadione (mean 2.46 doses and mean dose 7.95 mg, 72.74% intravenously). Child-Pugh scores were higher in phytonadione patients (8.7 vs 9.93, <i>P</i> = .0003). There was no difference in the incidences of new bleeding (9.20 vs 13.04%, <i>P</i> = .492) or thrombosis (3.45 vs 0%, <i>P</i> = .203) between the control and phytonadione groups. After phytonadione administration, there was no change in INR, while INR increased by 0.24 in the control group (<i>P</i> = .025). <b>Conclusion:</b> In chronic liver disease patients who were not bleeding, phytonadione did not reduce INR or the incidence of new bleeding.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"660-665"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cefepime/Enmetazobactam.","authors":"Andrew R Staten, Danial E Baker","doi":"10.1177/00185787241269112","DOIUrl":"10.1177/00185787241269112","url":null,"abstract":"<p><p>Each month, subscribers to <i>The Formulary Monograph Service</i> receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of <i>The Formulary, Hospital Pharmacy</i> publishes selected reviews in this column. For more information about <i>The Formulary Monograph Service</i>, contact Wolters Kluwer customer service at 866-397-3433.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"606-613"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on Reliability in Healthcare Training and Critical Evaluation of ChatGPT AI Performance: Simulation of the Admission Test for the Hospital Pharmacy Specialization School in Turin, Italy.","authors":"Eleonora Castellana","doi":"10.1177/00185787241299039","DOIUrl":"10.1177/00185787241299039","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241299039"},"PeriodicalIF":0.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist-led Transitions of Care: A Cohort Study on Admission Medication History Factors and Adjustments to the Discharge Medication List.","authors":"Tatianna N Pollak, Colleen M Renier, John P Curley, Irina V Haller","doi":"10.1177/00185787241298132","DOIUrl":"10.1177/00185787241298132","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt;Patients are at risk of experiencing medication errors during each transition of care (TOC), which can result in adverse drug events and readmissions. Implementing a pharmacist-led TOC service can optimize medication safety and patient outcomes by identifying and correcting medication discrepancies prior to hospital discharge. A pharmacist-led TOC service at a tertiary care center expanded services to review medications at discharge for all enrolled hospitalized patients, but data collection and review had yet to be performed. &lt;b&gt;Objective:&lt;/b&gt; The purpose of this study was to evaluate the number of patients with a medication discrepancy identified at hospital discharge in a pharmacist-led TOC service. &lt;b&gt;Methods:&lt;/b&gt; This was a single center, retrospective cohort study conducted at a tertiary care facility. Admission medication histories were completed by pharmacists in the emergency department and inpatient units. TOC discharge medication reconciliations were completed by pharmacists prior to hospital discharge. The study included hospitalized adult patients with a pharmacist-completed admission medication history and discharge medication reconciliation between July 1, 2021, to September 30, 2021. Patients readmitted within the study period were included more than once if study criteria were met. Patients who left against medical advice, discharged to hospice, or expired were excluded from the study. &lt;b&gt;Results:&lt;/b&gt; A total of 213 patients met inclusion criteria for this study, with 214 patient encounters included in the analysis after accounting for readmissions. More patients had a TOC medication discrepancy identified at discharge when admission medication histories were completed less than or equal to 24 hours after hospital admission versus greater than 24 hours after hospital admission (28.2% vs 23.6%, OR: 1.269, 95% CI: 0.658, 2.448). Fewer patients had a TOC discrepancy at discharge when fewer PTA medications were changed versus more PTA medications were changed during the admission medication history (0-1 medication changes vs ≥10 medication changes: 19% vs 29.4%, OR: 1.780, 95% CI: 0.730, 4.339). Fewer patients had a TOC discrepancy at discharge when admission medication histories were completed in the emergency department versus on the inpatient units (22.4% vs 28.6%, OR: 0.721, 95% CI: 0.366, 1.420). A similar number of patients had a TOC discrepancy at discharge regardless of the number of unit transitions throughout their hospital stay (1-2 transitions vs ≥4 transitions: 25.9% vs 25.5%, OR: 0.977, 95% CI: 0.456, 2.096). &lt;b&gt;Conclusions:&lt;/b&gt; One in four patients enrolled in the pharmacist-led TOC service had a medication discrepancy identified at discharge. This was irrespective of when the admission medication history was completed, how many changes were made, or how many times the patient transitioned units. Therefore, medication reconciliation at discharge should be a service provided to all admitted patie","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241298132"},"PeriodicalIF":0.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}