The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings

Kovačević, Tijana; Nedinić, Sonja; Barišić, Vedrana; Miljković, Branislava; Fazlić, Emir; Vukadinović, Slobodan; Kovačević, Pedja

doi:10.3390/pharmacy13040107

Open AccessArticle

The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings

by

Tijana Kovačević

^1,2,*

,

Sonja Nedinić

¹,

Vedrana Barišić

^1,2

,

Branislava Miljković

³

,

Emir Fazlić

⁴,

Slobodan Vukadinović

⁵ and

Pedja Kovačević

^2,6

¹

Pharmacy Department, University Clinical Centre of the Republic of Srpska, Dvanaest Beba bb, 78000 Banja Luka, Bosnia and Herzegovina

²

Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina

³

Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000 Belgrade, Serbia

⁴

Faculty of Pharmacy, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina

⁵

Abdominal Surgery Department, University Clinical Centre of the Republic of Srpska, Dvanaest Beba bb, 78000 Banja Luka, Bosnia and Herzegovina

⁶

Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba bb, 78000 Banja Luka, Bosnia and Herzegovina

^*

Author to whom correspondence should be addressed.

Pharmacy 2025, 13(4), 107; https://doi.org/10.3390/pharmacy13040107

Submission received: 29 May 2025 / Revised: 16 July 2025 / Accepted: 24 July 2025 / Published: 2 August 2025

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Abstract

Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in identifying pharmacotherapy-related issues upon patient admission in a low-resource setting. A prospective observational study was conducted at a university hospital between 1 March and 31 May 2023. Within 24 h of admission, a clinical pharmacist documented each patient’s pre-admission medication regimen and compared it with the medication history obtained by the admitting physician. Discrepancies and pharmacotherapy problems were subsequently identified. Among 65 patients, pharmacists documented 334 medications versus 189 recorded by physicians (p < 0.01). The clinical pharmacist identified 155 discrepancies, 112 (72.26%) of which were unintentional. The most frequent type was drug omission (91.07%), followed by incorrect dosage (4.46%), incorrect dosing interval (2.68%), and medications with unknown indications (1.79%). Most discrepancies were classified as errors without harm (53.57%), while 41.07% were potentially harmful. These findings underscore the importance of integrating clinical pharmacists into the healthcare team. Their active participation during hospital admission can significantly enhance medication safety and reduce preventable adverse drug events.

Keywords: medication errors; pharmacist; clinical; hospital admission; medication reconciliation

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MDPI and ACS Style

Kovačević, T.; Nedinić, S.; Barišić, V.; Miljković, B.; Fazlić, E.; Vukadinović, S.; Kovačević, P. The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings. Pharmacy 2025, 13, 107. https://doi.org/10.3390/pharmacy13040107

AMA Style

Kovačević T, Nedinić S, Barišić V, Miljković B, Fazlić E, Vukadinović S, Kovačević P. The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings. Pharmacy. 2025; 13(4):107. https://doi.org/10.3390/pharmacy13040107

Chicago/Turabian Style

Kovačević, Tijana, Sonja Nedinić, Vedrana Barišić, Branislava Miljković, Emir Fazlić, Slobodan Vukadinović, and Pedja Kovačević. 2025. "The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings" Pharmacy 13, no. 4: 107. https://doi.org/10.3390/pharmacy13040107

APA Style

Kovačević, T., Nedinić, S., Barišić, V., Miljković, B., Fazlić, E., Vukadinović, S., & Kovačević, P. (2025). The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings. Pharmacy, 13(4), 107. https://doi.org/10.3390/pharmacy13040107

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The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings

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