Journal of the American College of Clinical Pharmacy : JACCP最新文献

{"title":"Retrospective assessment of medication patterns among candidates evaluated for living kidney donation","authors":"Drew T. Dickinson Pharm.D., MPH,&nbsp;Linh Nguyen Pharm.D.,&nbsp;Xinqi Liu Pharm.D.,&nbsp;Gianna Castro,&nbsp;Morgan Cherry B.S.,&nbsp;Fadel Dadabaev,&nbsp;Hercys Sanchez Rodriguez,&nbsp;Gregory E. Malat Pharm.D.,&nbsp;Abigail Forte Pharm.D.,&nbsp;Ty B. Dunn M.D., M.S.,&nbsp;Robert R. Redfield III M.D.,&nbsp;Amanda Leonberg-Yoo M.D., M.S.,&nbsp;Jennifer Trofe-Clark Pharm.D., FCCP","doi":"10.1002/jac5.1988","DOIUrl":"https://doi.org/10.1002/jac5.1988","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medication use in living kidney donor (LKD) candidates may have important implications for evaluation and donation care. We sought to characterize LKD candidate medication use through medication histories conducted at nephrologist evaluation and transplant pharmacist preoperative visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center cohort study included adult LKD candidates evaluated for donation between October 1, 2019 and October 1, 2021. Scheduled and as-needed medications for each candidate were abstracted from pre-donation medication histories collected at the evaluation visit with the nephrologist and the preoperative visit with the transplant pharmacist, if approved for donation. Medication histories from each visit were compared with each other and evaluated by therapeutic class frequency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 213 LKD candidates (112 approved for donation and 101 declined for donation), 198 (93.0%) candidates were taking at least one prescription medication, over-the-counter agent, or dietary supplement. Antidepressants and antihypertensives were the most common prescription agents used among candidates, with antihypertensives more common among declined donors (20.8% vs. 10.7%, <i>p</i> = 0.042). Nonsteroidal anti-inflammatory drugs were more commonly identified at the evaluation visit of approved candidates compared to the preoperative visit (29.5% vs. 0.9%, <i>p</i> &lt; 0.001) and dietary supplements were more commonly identified at the preoperative visit compared to the evaluation visit (49.1% vs. 59.8%, <i>p</i> = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The frequency of nonsteroidal anti-inflammatory drugs decreased greatly between the evaluation and preoperative visit, likely reflective of discontinuation pre-donation. Characterizing medication use among candidates evaluated for LKD donation may assist donor programs with developing more targeted patient medication education. Nearly all LKD candidates were taking a medication or dietary supplement pre-donation. Transplant pharmacists are uniquely positioned to perform medication reconciliations and can also offer guidance to other team providers on best practices for this process. A better understanding of medication patterns in this population may also aid with further developing care guidelines for LKD evaluation and pre-/postoperative LKD care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jac5.1988","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141584124","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":"Case series: Perioperative management of patients in the ICU","authors":"Melanie Smith Condeni Pharm.D.","doi":"10.1002/jac5.1979","DOIUrl":"https://doi.org/10.1002/jac5.1979","url":null,"abstract":"","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best practices in online/distance pharmacy practice course didactic instruction","authors":"Dawn E. Havrda Pharm.D., FCCP,&nbsp;Andrew J. Crannage Pharm.D., FCCP,&nbsp;Angela L. Bingham Pharm.D., FCCP,&nbsp;Kristen M. Cook Pharm.D.,&nbsp;Susan E. Hamblin Pharm.D.,&nbsp;Andie E. Lloyd Pharm.D.,&nbsp;J. Russell May Pharm.D.,&nbsp;Jessica R. Merlo Pharm.D.,&nbsp;Kaely G. Miller Pharm.D., MBA,&nbsp;Christina A. Spivey Ph.D.","doi":"10.1002/jac5.1983","DOIUrl":"https://doi.org/10.1002/jac5.1983","url":null,"abstract":"<p>This commentary provides an overview of the current literature and best practices for online learning and assessment within the didactic curriculum of pharmacy education, building on the 2022 ACCP commentary addressing remote experiential learning. Lessons learned from online delivery of curricula and best practices for programs to create the optimal online learning environment for students are reviewed. Although benefits of online learning have been found, such as flexibility, convenience, and efficient use of time, with similar short-term student performance, the potential long-term implications on pharmacy students are not fully known, particularly concerning board pass rates, job attainment, and knowledge/skills application in the workplace. This commentary reviews and recommends the types of teaching modalities that align best with an online format for knowledge acquisition and student satisfaction. The most challenging part of didactic curricula to teach remotely is skills development. Proficiency in skills (e.g., compounding preparations or physical assessment) is best evaluated in person to promote student self-confidence in pharmacy practice and patient care. This commentary reviews the needed components for designing quality online courses, all in the context of remembering the significance of instructor engagement. The commentary also discusses the importance of bidirectional feedback for the instructor and student and the deliberate use of formative assessments of learning to gauge student performance. A review of online summative and high-stakes assessments is included with a focus on ensuring academic integrity while also minimizing any impact on student performance and anxiety. As pharmacy education has learned from the experiences with the COVID-19 transition to online learning, consideration should be given to best practices regarding when and how to use online modalities to teach students and foster student learning. Regardless of the format, courses should engage the student and instructor and be evaluated routinely to promote achievement of learning outcomes.</p>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141583853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A change to the pathway: The Impact of the Supreme Court of the United States affirmative action decision on clinical pharmacy and a call to action for pharmacists","authors":"Jacinda C. Abdul-Mutakabbir Pharm.D., MPH,&nbsp;Tyler Marie Kiles Pharm.D.,&nbsp;John M. Allen Pharm.D., FCCP,&nbsp;Hope E. Campbell Pharm.D.","doi":"10.1002/jac5.1961","DOIUrl":"10.1002/jac5.1961","url":null,"abstract":"","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Pharmacist-led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge”","authors":"","doi":"10.1002/jac5.1995","DOIUrl":"https://doi.org/10.1002/jac5.1995","url":null,"abstract":"<p>\u0000 <span>Patel, N</span>, <span>Dannemiller, RE</span>, <span>Kovacevic, MP</span>, <span>Dube, KM</span>, <span>Lupi, KE</span>, <span>Blum, RC</span>, <span>Crowley, KE</span>. <span>Pharmacist-led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge</span>. <i>J Am Coll Clin Pharm</i>. <span>2024</span>; <span>7</span>(<span>4</span>): <span>358</span>–<span>366</span>. https://doi.org/10.1002/jac5.1924\u0000 </p><p>In Table 3, the text “stimulants” was incorrectly spelled as “simulants.”</p><p>We apologize for this error.</p>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jac5.1995","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169840","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":"Age-based transitions of care: Where is the pharmacist?","authors":"Sara W. Hovey Pharm.D.,&nbsp;Christine Tabulov Pharm.D.,&nbsp;Kelly L. Matson Pharm.D.,&nbsp;Hanna Phan Pharm.D., FCCP","doi":"10.1002/jac5.1962","DOIUrl":"10.1002/jac5.1962","url":null,"abstract":"","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141395071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of the key potentially inappropriate drugs in pediatrics list within the electronic health record in a tertiary care children's hospital","authors":"Seerat Kapoor Pharm.D.,&nbsp;William A. Mabry Pharm.D., MBA,&nbsp;Dhyana Naik Pharm.D.,&nbsp;Kelly S. Bobo Pharm.D., MBA","doi":"10.1002/jac5.1975","DOIUrl":"10.1002/jac5.1975","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The key potentially inappropriate drugs in pediatrics (KIDs) List raises awareness of medications and excipients that should be used cautiously in specific age groups, appropriately monitored, or avoided. This project used the KIDs List to identify opportunities to improve our clinical decision support program and adjust the medication formulary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our team used the Plan, Do, Study, Act (PDSA) cycle to assess items and take actions that included no change, creation of an alert or task for pharmacists or providers, referral for additional study, inventory modification, and modification of dose range alerts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our initial assessment of 34 formulary items identified 10 items (29%) with the recommendations from the KIDs list in place; 72% (24/34) were referred for further study. In the preliminary phase, 15% (5/34) were submitted to pharmacy information technology (IT) to develop an alert, 24% (8/34) needed inventory modifications, 24% (8/34) required dose range alert adjustments, and 9% (3/34) were referred for additional study. Final actions included the development of six new alerts, inventory modification for nine medications, dose range checking for eight medications, and no change for 11 medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The PDSA cycle was an effective process that allowed the team to assess each medication using a systematic approach and encouraged additional analysis when needed. We were able to compare the KIDs List recommendations to current clinical decision support parameters and make adjustments or develop new alerts within the electronic health record to match the current standard. This initiative had a team-based approach, included key stakeholders, and is replicable in other institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a rule-based decision tool for medication dose selection to improve patient safety and the need for pharmacist intervention","authors":"Tyler Finocchio Pharm.D., MHIIM,&nbsp;Gregory Jaszczur Pharm.D.","doi":"10.1002/jac5.1981","DOIUrl":"10.1002/jac5.1981","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>An assortment of alerts has been employed to influence provider order entry, yet many medication orders still require dose adjustment by pharmacists upon order verification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The primary goals of this study were to evaluate the impact of adding rule-based decision support to the computerized provider order entry system on the need for medication dose adjustment by a pharmacist and the occurrence of acute kidney injury (AKI) among patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective, pre- and post-implementation observational study on the integration of rule-based logic into the computerized provider order entry system to automatically select default doses and frequencies for weight-based or renally-cleared medications in alignment with health system guidelines. The primary end points were the proportion of medication orders that required pharmacist intervention for dose adjustment and the number of times the AKI pop-up alert was triggered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After inclusion and exclusion criteria were applied to all available orders, there were 47 393 and 45 767 orders included for final analysis in the pre- and post-implementation periods, respectively. The post-implementation period showed a significant reduction in pharmacist dosing interventions, with a relative risk of 0.42 (95% confidence interval [CI]: 0.40–0.43; <i>p</i> &lt; 0.0001) and a reduction in AKI (relative risk = 0.58 [95% CI: 0.53–0.64; <i>p</i> &lt; 0.0001]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates the potential of rule-based decision support to improve initial medication dose selection, reduce the occurrence of AKI, and reduce pharmacist workload, all without increasing alert fatigue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy-led optimization of transitions of care in patients with heart failure","authors":"Julianne M. Fallon Pharm.D.,&nbsp;Emily McElhaney Pharm.D.,&nbsp;Keith Anderson Pharm.D.,&nbsp;Daniel A. Lewis Pharm.D., MBA,&nbsp;J. Bradley Williams Pharm.D.","doi":"10.1002/jac5.1982","DOIUrl":"10.1002/jac5.1982","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Effective transitional care for patients with heart failure is essential to ensure optimal utilization of guideline-directed medical therapy. Clinical pharmacists and specially trained pharmacy technicians have unique skillsets that enable them to improve care transitions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the implementation of a comprehensive pharmacy transitions of care program in an acute heart failure population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective, single center, single-arm study evaluating pharmacy-delivered transitions of care services (admission and discharge medication reconciliation, medication cost assessment, medication counseling, bedside delivery of discharge medications, and post-discharge phone calls) for patients discharged from the heart failure service. The primary outcome was the completion rate of transitions of care services. Secondary outcomes included the medication intervention rate and types of interventions made, medication classes assessed for cost, discharge medication prescription captured, and 30-day all-cause readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five hundred and ninety-five patients were eligible for the transitions of care program. Admission and discharge medication reconciliations were completed in 68.1% and 92.1% of patients, respectively. Medication cost assessments were completed for 39.8% of patients. Heart failure medication counseling prior to discharge was completed for 83.9% of patients. Discharge prescription capture rate was 56.5% and bedside prescription delivery was provided for 27.8% of patients. The discharge medication reconciliation intervention rate was 37.4%, with the most common intervention being dose adjustment. Post-discharge outreach was conducted for 229 patients, with education provided for 69.4% and an intervention rate of 43.7%. The 30-day all-cause readmission rate was lower for patients on the heart failure service compared with the institution (10.1% vs 16.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High rates of completion and utilization were identified after the implementation of a comprehensive pharmacy transitions of care program. Utilization of clinical pharmacists and pharmacy technicians during transitions of care improved medication access, patient education, and reduced medication-related problems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jac5.1982","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265394","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 pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical center","authors":"Linda Zheng Pharm.D.,&nbsp;Tiffany Pon Pharm.D.,&nbsp;Sarah Bajorek Pharm.D.,&nbsp;Kathie Le Pharm.D.,&nbsp;Rebecca Hluhanich Pharm.D.,&nbsp;Yunyi Ren M.S.,&nbsp;Machelle Wilson Ph.D.","doi":"10.1002/jac5.1980","DOIUrl":"10.1002/jac5.1980","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medication errors during hospital discharge can lead to adverse outcomes, medication-related readmissions, and increased health care costs. Pharmacist-led medication reconciliation at discharge is a potential solution to mitigate poor outcomes and optimize medication safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to quantify medication errors identified at discharge and characterize the severity of patient harm prevented following pharmacist-led discharge medication reconciliation. Cost avoidance analysis was conducted to determine its associated financial impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients, who were discharged from an adult internal medicine service during October 2022, were included in this one-month pilot prospective quality improvement study. The number of errors at discharge were documented, categorized by type, and adjudicated for severity of potential harm. Error severity was classified based on a modified National Coordinating Council for Medication Error Reporting and Prevention Medication Error Index. Cost avoidance was calculated based on whether each error would have resulted in additional medical encounters and length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-one patients were included in the analysis. Forty errors were identified by pharmacist-led medication reconciliation at discharge, with a mean of 1.3 ± 1.9 errors per patient and 68% of patients having at least one error. The most common errors were duplication of therapy (25%) and medication access barriers at discharge (25%). The severity of errors included low (22.5%), serious (75%), and life-threatening harm (2.5%). Thirty-five percent of errors could have led to emergency visits or hospital readmissions. The estimated total cost for errors was $25 600. Pharmacist labor cost for reconciliation was $816. Cost avoidance was $24 784 from the 14 errors at discharge that could have resulted in additional emergency or inpatient visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pharmacist-led medication reconciliation at discharge may prevent harm from reaching patients, decrease cost from unnecessary health encounters, and stop the error from continuing across transitions of care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jac5.1980","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268481","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}