Impact of PharmaCloud on Pharmacist-Led Medication Reconciliation Efficiency and Error Detection Among Taiwanese Inpatients

NCT07727278 — Not applicable, Completed, 93 participants, Far Eastern Memorial Hospital

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Impact of Integrating PharmaCloud on Pharmacist-Led Medication Reconciliation Efficiency and Error Detection Among Internal Medicine Inpatients: A Prospective Non-Randomized Study in Taiwan

Registry	NCT07727278
Status	Completed
Phase	Not applicable
Study type	Interventional; non randomized, parallel, masking: none, health services research
Enrollment	93 (Actual)
Sponsor	Far Eastern Memorial Hospital (Other); collaborators: National Yang Ming Chiao Tung University
Conditions	Medication Reconciliation, Best Possible Medication History, Medication Discrepancy
Interventions	PharmaCloud-integrated medication reconciliation (Other)
Dates	start 2024-05-01, primary completion 2024-11-30, completion 2024-11-30, first posted 2026-07-27, last updated 2026-07-27
Locations	1 site in Taiwan

-Summary

Taiwan's National Health Insurance Administration PharmaCloud provides cross-institutional medication access to reimbursed medication records to support best possible medication history (BPMH) compilation. However, its utility among internal medicine inpatients, who typically present with complex regimens and frequent medication changes, remains understudied. This study aims to evaluate the impact of PharmaCloud integration on pharmacist-led medication reconciliation (MedRec) efficiency and error detection among internal medicine inpatients at both admission and discharge.

The non-randomized, single-center study was conducted from May to November 2024 at the Far Eastern Memorial Hospital in Taiwan. Internal medicine inpatients taking at least one pre-admission chronic medication were enrolled and assigned to standard medication reconciliation protocol (control) or PharmaCloud-integrated medication reconciliation (experimental). Best possible medication history compilation time was recorded across two stages: preparation and interview. Medication discrepancies were identified at admission and discharge and classified as intentional or unintentional.

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+Arms and interventions

Arm	Type	Interventions	Description
Standard medication reconciliation	No intervention		Best possible medication histories (BPMHs) were constructed within 72 hours of patient admission. First, designated pharmacists compiled a preliminary BPMH by reviewing in-house electronic medical records. Then, pharmacists conducted patient or caregiver interviews to form the finalized BPMH.
PharmaCloud-intergrated medication reconciliation	Experimental	Other: PharmaCloud-integrated medication reconciliation	Best possible medication histories (BPMHs) were constructed within 72 hours of patient admission. First, designated pharmacists compiled a preliminary BPMH by reviewing in-house electronic medical records and PharmaCloud data. Then, pharmacists conducted patient or caregiver interviews to form the finalized BPMH.

PharmaCloud-integrated medication reconciliation (Other): The intervention entailed supplementing in-house electronic medical record with data from PharmaCloud, a platform launched by Taiwan's National Health Insurance Administration to enable cross-institutional access to reimbursed medication records.

+Outcome measures

Primary outcomes

Best possible medication history compilation efficiency [From patient's time of hospital admission to 72 hours post-admission.]: The first outcome measure was best possible medication history (BPMH) compilation efficiency, which was measured in minutes as three metrics: preparation time (stage 1), measured from the start of electronic medical record (EMR) and PharmaCloud review to the completion of the preliminary BPMH; interview time (stage 2), measured from the start to the end of the face-to-face interview; and total BPMH compilation time, the sum of stage 1 and 2.

Secondary outcomes

Medication error detection rate [Admission: Unintentional discrepancies identified from patient's time of admission to 72 hours post-admission. Discharge: Unintentional discrepancies identified immediately prior to patient's departure from the facility.]: Medication error detection rate was defined as the proportion of participants with at least one identified unintentional discrepancy at either admission or discharge. All identified discrepancies were categorized as either intentional or unintentional, depending on whether or not the medication changes were consciously made by the prescribers, respectively.

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age 18 years or older
* Use of at least one pre-admission medication for a chronic disease

Exclusion Criteria:

* If patient was discharged within 48 hours of admission
* If patient was scheduled for surgery during their inpatient stay

+Locations (1)

Facility	City	Country	Status
Far Eastern Memorial Hospital	New Taipei City	Taiwan

+Publications

Huang PP, Poon SY, Chang SH, Kuo CW, Chien MW, Chen CC, Chiang SC. Improving the Efficiency of Medication Reconciliation in Two Taiwanese Hospitals by Using the Taiwan National Health Insurance PharmaCloud Medication System. Int J Gen Med. 2023 Jan 19;16:211-220. doi: 10.2147/IJGM.S389683. eCollection 2023. PMID 36699342