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

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.

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