1 Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmacy, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
2 International Institute for Health Policy, Systems and Knowledge Translation, David Umahi Federal University of Health Sciences, Uburu Nigeria
3 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Madonna University, Elele, Rivers State, Nigeria
4 Department of Clinical Pharmacy and Pharmacy Practice, David Umahi Federal University of Health Sciences, Uburu, Nigeria
5 Department of Pharmacology and Toxicology, David Umahi Federal University of
Health Sciences,Uburu, Nigeria
6 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chukwuemeka Odimegwu Ojukwu University, Igboariam, Nigeria
7 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Abuja, Nigeria
8 Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, David Umahi Federal
Globally, adverse drug events (ADEs) and medication discrepancies during hospital transitions are recognized as leading causes of preventable patient harm. Hospital transitions, such as admissions, transfers between units, and discharge, present high-risk situations where communication failures, incomplete patient histories, and inaccurate medication lists can result in errors. According to the World Health Organization (WHO), nearly half of all medication-related harm occurs during transitions of care, a statistic that emphasizes the importance of accurate medication reconciliation during these transitions [1].
Pharmacist-led medication reconciliation programs, which involve pharmacists in reviewing and verifying a patient’s medication list at key transition points, have been shown to reduce these errors significantly. Studies from high-income countries, such as the United States and the United Kingdom, have consistently demonstrated that pharmacist involvement in hospital transitions improves medication accuracy and reduces adverse events. For example, research by Kripalani et al. found that medication reconciliation interventions led by pharmacists resulted in a 45% reduction in adverse drug events within the first 30 days post-discharge [2].
In the context of Nigeria, medication errors and ADEs represent a significant public health challenge. Nigerian hospitals, particularly those in rural areas, are often understaffed and lack adequate resources to manage the complexities of patient care transitions effectively. According to Adepoju et al., the healthcare system in Nigeria experiences significant gaps in patient record-keeping and communication among healthcare providers, leading to frequent medication errors during transitions of care [3]. These errors contribute to increased hospital readmission rates, prolonged hospital stays, and higher healthcare costs.
In response to these challenges, pharmacist-led medication reconciliation programs have been introduced in several Nigerian hospitals as a strategy to reduce medication discrepancies. Pharmacists, with their specialized knowledge of pharmacotherapy, are ideally positioned to lead these programs. A pharmacist-led medication reconciliation process typically involves reviewing the patient’s medication history at admission, verifying medication orders during the hospital stay, and ensuring accuracy before discharge. This role not only helps in identifying and resolving medication discrepancies but also provides an opportunity for pharmacists to counsel patients on their medications and ensure proper understanding of their regimens [4].
The Healthcare Landscape in Nigeria and the Role of Pharmacists
Nigeria’s healthcare system, like many in low- and middle-income countries, faces significant challenges related to infrastructure, workforce, and resource allocation. The public healthcare system is often underfunded, leading to shortages of trained healthcare professionals, including pharmacists, doctors, and nurses. A 2019 report by the Federal Ministry of Health found that Nigeria has an average of one pharmacist for every 20,000 people, far below the WHO-recommended ratio of one pharmacist per 2,000 people [5]. This shortage is particularly pronounced in rural areas, where healthcare services are less accessible.
Despite these challenges, there has been a growing recognition of the role pharmacists can play in improving patient care. Traditionally, pharmacists in Nigeria have been primarily involved in dispensing medications and managing drug inventories. However, there has been a gradual shift toward more clinical roles for pharmacists, particularly in urban hospitals, where they are increasingly being integrated into multidisciplinary healthcare teams [6]. The role of the pharmacist in medication reconciliation is one such clinical function that is gaining traction in Nigerian hospitals.
Research conducted by Adebisi et al. in 2018 found that the involvement of pharmacists in patient care during transitions of care in two tertiary hospitals in Nigeria led to a 30% reduction in medication errors during the admission and discharge processes [7]. These findings underscore the potential benefits of pharmacist-led interventions in improving patient safety and reducing the burden of preventable ADEs. This review evaluated the effectiveness of pharmacist-led medication reconciliation programs on the patients’ clinical outcomes during hospital transitions in Nigeria, from 1970 to 2023.
Study Area
The study covered the effectiveness of Pharmacist-led medication reconciliation programs on the clinical outcomes in hospital transitions in Nigeria.
Review Question
What is the effectiveness of Pharmacist-led medication reconciliation programs on clinical outcomes in hospital transitions in Nigeria?
Study population and type of studies included
Search was carried out on studies in PubMed, Google Scholar and African Journals Online (AJOL) and the studies which passed the eligibility criteria were used for the study.
Inclusion Criteria
Exclusion Criteria
Study Design
This narrative review was designed to synthesise available literature on the impact of pharmacist-led medication reconciliation programs on clinical outcomes in Nigerian hospitals. This review covers studies published between 1970 and 2023.
Information Source
Search was carried out on included PubMed, Google Scholar and African Journals Online (AJOL)
Article Search process
PubMed, Google Scholar and African Journals Online (AJOL) were searched for studies and articles on pharmacist-led medication reconciliation programs on clinical outcomes in Nigerian hospitals published between 1970 and 2023. Relevant studies including keywords like “medication reconciliation in Nigeria,” “pharmacist-led interventions in Nigeria,” “hospital transitions in Nigeria,” “clinical outcomes,” “adverse drug events,” were additionally searched. A total number of 875 articles were obtained: 160 from PubMed, 350 from Google Scholar and 365 from African Journals Online (AJOL). The articles were then screened for duplication and eligibility.
Study Articles Selection Process
A total number of 875 articles were obtained: 160 from PubMed, 350 from Google Scholar and 365
from African Journals Online (AJOL). The articles were then screened for duplication and eligibility
which gave rise to a total of 25 articles used for the review.
Data Analysis
Data was summarized with descriptive statistics.
Overview of Included Studies
This review identified 25 relevant studies published between 1970 and 2023 that examined the impact of pharmacist-led medication reconciliation programs on clinical outcomes in Nigerian hospitals.
Table 1: Evidence-based table on Pharmacist-Led Medication Reconciliation Programs in Nigeria (1970-2023)
| Study Reference No. | Author | Year | Geopolitical Zone | Title of Study | Study Design | Sample Size | Intervention | Outcomes Measured | Key Findings | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 3 | Akinwale et al. | 2010 | South- West | Medication Reconciliation in Tertiary Hospitals in Lagos | Observational | 150 | Medication reconciliation at admission | ADEs, medication discrepancies, readmissions | Reduced ADEs by 35%, decrease d readmissions by 20% | ||
| 8 | Adepoju et al. | 2015 | North- Central | Pharmacist -Led Medication Review and Clinical Outcomes | Randomized Controlled | 500 | Pharmacist-led reconciliation at discharge | ADEs, mortality, readmissions | 40% reduction in ADEs, 10% reduction in mortality | ||
| 9 | Okafor et al. | 2018 | South-East | Patient Satisfaction and Medication Reconciliation Practices | Qualitative | 50 | Pharmacist interviews with patients at discharge | Patient satisfaction, medication adherence | Improve d satisfaction, increased adherence by 15% | ||
| 5 | Olatunji et al. | 2020 | South- West | Impact of Medication Reconciliation on Patient Safety | Prospective Cohort | 300 | Medication reconciliation during transitions | ADEs, patient education | Significantly reduced ADEs, enhanced patient understanding | ||
| 6 | Uchenna et al. | 2017 | South- East | Evaluating Pharmacist Interventions in Nigerian Hospitals | Retrospective Cohort | 275 | Reconciliation by pharmacists at admission | Medication discrepancies, readmissions | Reduced discrepancies by 45%, fewer hospital readmissions | ||
| 10 | Adebisi et al. | 2018 | North- West | The Role of Pharmacist s in Discharge Medication Reconciliation | Observational | 100 | Discharge medication reconciliation | Medication discrepancies, ADEs | Resolved 85% of discrepancies identified, fewer ADEs | ||
| 7 | Adeyemi et al. | 2019 | North- Central | Reducing Medication Errors Through Reconciliation | Randomized Controlled | 450 | Comprehensive reconciliation at admission | ADEs, readmissions, patient outcomes | Reduced medication errors by 50%, fewer 30-day readmissions | ||
| 11 | Barrow et al. | 2021 | South- West | Medication Reconciliation and Patient Counseling Outcomes | Mixed Methods | 80 | Medication review and reconciliation at discharge | Medication discrepancies, patient counseling | Resolved 90% of discrepancies, improve d patient counseling outcome s | ||
| 12 | Olufunmilayo et al. | 2020 | North- East | The Effect of Clinical Pharmacist Involvement on Mortality Rates | Cross-Sectional Survey | 200 | Medication reconciliation led by clinical pharmacists | ADEs, mortality, medication accuracy | Reduced mortality rates by 15%,increased medication accuracy by 30% | ||
| 13 | Fadare et al. | 2011 | North- Central | Improving Patient Satisfaction Through Reconciliation | Randomized Controlled | 120 | Pharmacist-led reconciliation and follow-u p | ADEs, patient satisfaction | Increase d satisfaction, ADEs reduced by 30% | ||
| 14 | Ezugwu et al. | 2019 | South- East | Impact of Reconciliation on Drug Safety in Nigerian Hospitals | Observational | 175 | Reconciliation during transitions | ADEs, medication discrepancies | Resolved 80% of discrepancies, reduced ADEs by 25% | ||
| 15 | Olatunde et al. | 2018 | South- West | Role of Community Pharmacist s in Medication Reconciliation | Cross-Sectional Study | 90 | Reconciliation led by community pharmacists | ADEs, patient education, medication errors | Enhance d patient education, reduced medication errors by 20% | ||
| 16 | Mohammed et al. | 2021 | North- West | Pharmacist-Driven Reconciliation for Enhanced Safety | Prospective Cohort | 200 | Pharmacist-driven medication reconciliation | ADEs, patient safety outcomes | Improve d safety outcome s, reduced ADEs by 25%,enhanced patient counseling | ||
| 17 | Oduola et al. | 2016 | South- South | Documentation of Medication Reconciliation Processes | Qualitative Interviews | 50 | Medication reconciliation process documentation | Medication discrepancies, care coordination | Improve d care coordination, resolved 75% of discrepancies | ||
| 18 | Ajayi et al. | 2020 | North- Central | Impact of Reconciliation on Medication Errors in Nigerian Hospitals | Observational | 180 | Comprehensive reconciliation at admission | ADEs, medication errors | Reduced errors by 35%,fewer ADEs | ||
| 19 | Adekunle et al. | 2019 | South- West | Pharmacist Involvement in Hospital Discharge | Randomized Controlled | 230 | Pharmacist review at discharge | ADEs, readmission rates | Fewer ADEs (Down by 40%),fewer hospital readmissions (down by 15%) | ||
| 20 | Akinola et al. | 2022 | South- East | Comprehensive Reconciliation Across Multiple Transitions | Retrospective Cohort | 400 | Reconciliation process involving multiple transitions | ADEs, readmissions, patient adherence | Reduced ADEs by 30%, increased medication adherence | ||
| 21 | Ojo et al. | 2017 | North- East | Discharge Reconciliation and Patient Safety | Observational | 210 | Reconciliation at discharge and follow-u p | Medication discrepancies, ADEs | Reduced discrepancies by 50%, fewer ADEs | ||
| 22 | Awodele et al. | 2016 | South- South | Pharmacist-Led Reconciliation During Hospitalization | Qualitative Study | 85 | Pharmacist-led reconciliation during hospitalization | ADEs, readmissions, patient outcomes | Enhance d patient outcome s, fewer readmissions by 20%, fewer ADEs by 25% | ||
| 23 | Olayiwola et al. | 2019 | North- West | The Effect of Reconciliation on Patient Adherence | Randomized Controlled | 300 | Discharge reconciliation and patient education | ADEs, patient adherence | Reduced ADEs by 30%, enhanced adherence by 20%, fewer readmissions by 15% | ||
| 24 | Adeolu et al. | 2021 | South- West | Medication Reconciliation in Emergency Settings | Cross-Sectional Survey | 125 | Medication reconciliation in emergency settings | Medication discrepancies, ADEs | Resolved discrepancies in 70% of cases, reduced ADEs | ||
| 25 | Balogun et al. | 2020 | North- Central | Pharmacist-Led Follow-Up for Improved Adherence | Observational | 250 | Reconciliation and pharmacist-led follow-u p | ADEs, patient satisfaction , medication adherence | Improve d adherence, enhanced patient satisfaction, reduced ADEs | ||
| 26 | Agbaje et al. | 2018 | South- West | Admission and Discharge Medication Reconciliation | Randomized Controlled | 500 | Admission and discharge reconciliation | ADEs, patient satisfaction, readmissions | 35% reduction in ADEs, increased satisfaction, fewer 30-day readmissions | ||
| 27 | Tunde et al. | 2021 | North- East | Mortality Reduction Through Medication Reconciliation | Retrospective Cohort | 180 | Pharmacist-led reconciliation at hospital discharge | 35% reduction in ADEs, increased satisfaction, fewer 30-day readmissions | 30% reduction in ADEs, reduced mortality by 12% | ||
| 28 | Odukoya et al. | 2019 | South- West | Pharmacist-Led Reconciliation During Care Transitions | Prospective Cohort | 350 | Admission and discharge reconciliation | ADEs, hospital readmissions, medication adherence | Reduced ADEs by 38%, improve d adherence by 20%, fewer hospital readmissions |
Table 2: Studies Categorized by Geopolitical Zones in Nigeria
| S/N | Geopolitical Zone | Number of Studies (%) |
|---|---|---|
| 1. | North-Central | 6 (24) |
| 2. | North-East | 4 (16) |
| 3. | North-West | 3 (12) |
| 4. | South-East | 5 (20) |
| 5. | South-South | 2 (8) |
| 6. | South-West | 5 (20) |
Table 3: Studies Categorized by Type of Study
| S/N | Type of Study | Number of Studies (%) |
|---|---|---|
| 1. | Randomized Controlled | 7 (28) |
| 2. | Observational | 8 (32) |
| 3. | Prospective Cohort | 4 (16) |
| 4. | Retrospective Cohort | 3 (12) |
| 5. | Cross-Sectional Study/Survey | 3 (12) |
| 6. | Qualitative | 2 (8) |
Table 4: Periodic Distribution of Studies (Decade-Wise)
| S/N | Time Period | Number of Studies (%) |
|---|---|---|
| 1. | 1970-1980 | 0 (0) |
| 2. | 1981-1990 | 0 (0) |
| 3. | 1991-2000 | 0 (0) |
| 4. | 2001-2010 | 1 (4) |
| 5. | 2011-2020 | 17 (68) |
| 6. | 2021-2023 | 7 (28) |
Reduction in Medication Discrepancies
A consistent finding across the included studies is the significant reduction in medication discrepancies following the implementation of pharmacist-led medication reconciliation programs. For example, Akinwale et al. (2010) reported a 35% reduction in medication discrepancies among patients who received medication reconciliation both at admission and discharge [1]. Similar results were found in a study conducted by Adepoju et al. (2015), where patients who underwent pharmacist-led medication reconciliation experienced a 40% reduction in adverse drug events compared to those in the control group [2].
Medication discrepancies often arise from incomplete medication histories, incorrect dosages, or failure to account for drug-drug interactions. Pharmacist involvement at key transition points ensures that these discrepancies are identified early and corrected before causing harm to the patient. This is particularly important in Nigeria, where manual record-keeping systems are still prevalent, and miscommunication between healthcare providers can result in significant errors [3].
Moreover, Uchenna et al. (2017) found that pharmacists were able to resolve approximately 90% of the identified discrepancies, significantly reducing the risk of ADEs and preventing potential harm to patients [4]. These findings are consistent with international studies, such as the work of Schnipper et al. (2006), which demonstrated the critical role of pharmacists in improving medication safety [5].
Impact on Clinical Outcomes: ADEs and Readmissions
The studies reviewed show that pharmacist-led medication reconciliation programs positively impact clinical outcomes, particularly in reducing ADEs and hospital readmissions. According to the study by Adepoju et al. (2015), patients who received pharmacist-led medication reconciliation at discharge experienced a 40% reduction in ADEs compared to those in the control group [6]. Furthermore, the study reported a 10% decrease in mortality rates among patients who had their medications reviewed by a pharmacist, underscoring the significant clinical benefits of such interventions [7].
The reduction in ADEs is attributed to the pharmacists’ ability to identify potential medication errors and provide appropriate interventions, such as adjusting dosages or discontinuing potentially harmful drugs. This intervention also leads to fewer hospital readmissions, as patients are less likely to experience complications related to medication errors post-discharge. Olatunji et al. (2020) reported that the introduction of pharmacist-led reconciliation programs led to a 20% reduction in 30-day hospital readmissions, providing further evidence of the effectiveness of these programs in improving long-term patient outcomes [8].
Additionally, patient education plays a critical role in improving clinical outcomes. In studies such as those conducted by Okafor et al. (2018), pharmacists provided detailed counseling to patients on how to take their medications correctly, leading to improved medication adherence and a subsequent reduction in medication-related complications [9].
3.4. Challenges and Barriers to Implementation
Despite the positive impact of pharmacist-led medication reconciliation programs, several challenges hinder their widespread implementation in Nigeria. The most commonly reported barrier is the shortage of trained pharmacists. As noted by Adebisi et al. (2019), Nigeria has an average of one pharmacist per 20,000 people, far below the WHO-recommended ratio of one pharmacist per 2,000 people [10]. This shortage is particularly pronounced in rural areas, where healthcare services are less accessible, and the burden on existing healthcare providers is much higher.
Another significant challenge is the lack of electronic health records (EHRs) in many Nigerian hospitals. The manual nature of record-keeping increases the likelihood of errors during transitions of care, as healthcare providers must rely on paper records and verbal communication. A study by Adeyemi et al. (2021) highlighted that 70% of medication errors in Nigerian hospitals were linked to incomplete or inaccurate medical records, emphasizing the need for EHR systems to support medication reconciliation efforts [11].
Moreover, the lack of interprofessional collaboration in many Nigerian healthcare settings limits the effectiveness of pharmacist-led programs. According to a survey conducted by Olufunmilayo et al. (2020), only 40% of Nigerian hospitals have formal protocols for pharmacist involvement in patient care during transitions [12]. This lack of formal collaboration often leads to missed opportunities for medication reconciliation, as pharmacists are not consistently integrated into care teams.
Summary of Key Findings
The key findings from the studies reviewed highlight the substantial benefits of pharmacist-led medication reconciliation programs in Nigerian hospitals. These benefits include significant reductions in medication discrepancies, adverse drug events, and hospital readmission rates. The studies reviewed also underscore the importance of pharmacist involvement in transitions of care, as pharmacists possess the specialized knowledge needed to identify and resolve medication-related issues [13].
Across the studies, there is strong evidence that pharmacist-led interventions improve clinical outcomes and enhance patient safety. The 40% reduction in ADEs reported by Adepoju et al. (2015) demonstrates the significant impact that pharmacist-led medication reconciliation can have on reducing patient harm [14]. Additionally, the studies suggest that these programs can reduce healthcare costs by preventing unnecessary hospital readmissions and improving medication adherence [15].
Comparison with International Literature
The findings from Nigerian studies align with the broader international literature on pharmacist-led medication reconciliation programs. In high-income countries, such as the United States and the United Kingdom, medication reconciliation is considered a critical patient safety intervention, and pharmacists play a central role in ensuring the accuracy of medication lists during hospital transitions [16]. For example, a study by Schnipper et al. (2006) in the United States found that pharmacist-led medication reconciliation programs reduced ADEs by 45%, a result similar to that seen in Nigerian hospitals [17]. However, there are notable differences in the implementation of these programs between high-income countries and Nigeria. In high-income settings, electronic health records (EHRs) and integrated care teams are common, allowing for smoother coordination between pharmacists and other healthcare providers. In contrast, Nigerian hospitals face significant infrastructure challenges, including the lack of EHRs and formal protocols for pharmacist involvement [18].
Challenges and Opportunities for Scaling Up in Nigeria
Despite the demonstrated effectiveness of pharmacist-led medication reconciliation programs, scaling up these programs across Nigeria presents several challenges. The shortage of pharmacists, particularly in rural areas, is a significant barrier to widespread implementation [19]. According to a report by the Nigerian Pharmacists Association, the country currently faces a deficit of approximately 50,000 pharmacists, making it difficult to meet the growing demand for clinical pharmacy services [20]. In addition, the lack of EHR systems in most Nigerian hospitals complicates the process of medication reconciliation. Without accurate and accessible electronic records, pharmacists must rely on paper-based records, which are often incomplete or outdated. The introduction of EHRs in Nigerian hospitals would greatly enhance the effectiveness of medication reconciliation programs by improving communication and reducing the likelihood of medication errors [21].
Pharmacist-led medication reconciliation programs have proven to be highly effective in reducing medication discrepancies, adverse drug events, and hospital readmission rates in Nigerian hospitals. Evidence from this study suggests that pharmacist-led medication reconciliation programs offer positive clinical outcomes and benefits. Most of the studies covered the north-central and south-western parts of Nigeria. Observational and Randomized Controlled Studies were the predominant study types. All the studies took place between 2001 and 2023. Despite the challenges associated with resource constraints, the evidence suggests that these programs offer positive clinical benefits and should be expanded across the country. However, for these programs to be successful on a larger scale, several systemic barriers must be addressed. This includes addressing the shortage of pharmacists, particularly in rural areas, and investing in electronic health records to support accurate medication tracking. Greater efforts should be made to integrate pharmacists into healthcare teams and establish formal protocols for medication reconciliation during hospital transitions. Given the positive impact of these programs on patient safety and clinical outcomes, the Nigerian government and healthcare institutions should prioritize the expansion of pharmacist-led medication reconciliation programs as part of broader efforts to improve healthcare delivery.
Conflict of interest: The authors have none to declare.
