Discussion
This study revealed poor baseline medication reconciliation practice among pharmacists at both study sites. The focused educational intervention especially improved the practice of medication reconciliation by pharmacists at the intervention site. There was a reduction in medication discrepancies and an increase in detection and resolution of drug therapy problems by the intervention pharmacists.As evidenced by the lack of documented cases on medication reconciliation at baseline, and the slow build up to the adoption of the process during the study, the practice of medication reconciliation was a non-deliberate, haphazard, and unmonitored practice which was seldom done by a few pharmacists at both sites. This might be because medication reconciliation is not yet an established component of pharmacy practice in Nigeria [One of the processes during medication reconciliation is the review of patients’ past medications and comparing it with the newly prescribed medications. Healthcare practitioners, especially pharmacists, need to regularly educate their patients on the need to always bring their medications along for hospital visits. Studies from developed countries show that patients bringing their medication packs along for hospital appointments vary from one place to another [Medication reconciliation is a tool for detecting discrepancies in prescribed medications in diverse healthcare settings, or at different levels of care to update patient’s medication and avoid medication errors [A significant reduction in the occurrence of medication discrepancy from 43.75% to 25.0% at the intervention site, after the general educational intervention. Medication discrepancy observed among patients in related studies showed a range of 33.2% - 86.1% with a range of six to ten medications taken by the patients [19, 39, 22-24,]. It is expected that a much lower occurrence of medication discrepancy would be reported in developed countries where medication reconciliation is already an institutionalized practice. However, in the present study with a range of two to ten medications, the occurrence of medication discrepancies was significantly reduced from 43.75% to 25.0%. The higher average number of medications taken by patients in developed countries could be responsible for the higher medication discrepancies. This is logical, since medication discrepancy is likely to increase with increasing number of medications, especially as found in a geriatric population [Since patient safety is the primary goal of medication reconciliation, this study equipped pharmacists in the intervention site with knowledge and skill to improve patient safety by reducing medication discrepancies. Therefore, an institutionalized medication reconciliation practice will help to eventually reduce medication discrepancy in the long run.