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Impact of Medication Reconciliation Services on Medication List Accuracy among Patients Attending Nigerian Hospitals

Abstract

Medication errors arising from incomplete, inaccurate, or outdated medication information are important patient-safety concerns within healthcare systems. Patients attending hospitals in Nigeria may receive care from multiple healthcare providers and may use prescribed medicines, over-the-counter medicines, herbal preparations, or medications obtained from different healthcare facilities. Differences between a patient's actual medication use and the medication information documented in hospital records may result in omissions, duplications, incorrect dosages, drug interactions, or other medication-related problems. Medication reconciliation provides a structured process for obtaining, verifying, documenting, and communicating an accurate list of medicines used by a patient across transitions and points of care. Against this background, this study investigates the impact of medication reconciliation services on medication list accuracy among patients attending Nigerian hospitals. The study will be anchored on Systems Theory, the Donabedian Model of Healthcare Quality, and the Swiss Cheese Model of Patient Safety. Systems Theory emphasizes the interaction among patients, physicians, nurses, pharmacists, medical records personnel, and hospital information systems in maintaining accurate medication information. The Donabedian Model provides a framework for examining medication reconciliation as a healthcare process and medication-list accuracy as an outcome of quality care. The Swiss Cheese Model of Patient Safety explains how medication errors may occur when multiple weaknesses in healthcare processes and information systems align, while structured medication reconciliation can provide an additional safety barrier. Collectively, these theoretical perspectives provide a suitable framework for explaining how medication reconciliation services may influence medication list accuracy among patients attending Nigerian hospitals. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adult patients attending selected public and private hospitals across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, hospitals, clinical departments, and eligible patients. Medication reconciliation services will be assessed using indicators such as availability of formal reconciliation procedures, collection of complete medication histories, verification of prescribed medicines, identification of over-the-counter and herbal medicine use, confirmation of medication names, dosages, routes, frequencies, allergies, and adherence, involvement of pharmacists or other trained healthcare professionals, documentation of discrepancies, communication of medication changes, and reconciliation during admission, transfer, and discharge. Medication list accuracy will be assessed by comparing documented medication lists with a best possible medication history obtained through patient interviews, medication containers or prescriptions where available, pharmacy records, previous healthcare records, and other appropriate sources. Indicators will include the proportion of correctly documented medicines, omission errors, commission errors, dosage discrepancies, frequency discrepancies, duplicate medications, undocumented allergies, and the overall proportion of patients with accurate medication lists. Data will be collected using structured questionnaires, medication reconciliation forms, patient medical records, pharmacy records, prescription documents, medication lists, and hospital information systems where available. Descriptive statistics will be used to summarize participants' characteristics, medication use, reconciliation activities, and medication discrepancies. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of medication reconciliation services on medication list accuracy. Where a quasi-experimental design is adopted, medication list accuracy before and after implementation of medication reconciliation services may be compared with that of a comparison group or facility to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that medication reconciliation services have a significant positive impact on medication list accuracy among patients attending Nigerian hospitals. Patients who receive structured medication reconciliation are expected to have more complete and accurate medication lists than patients who receive routine medication documentation without formal reconciliation. Systematic verification of medication names, dosages, frequencies, routes, allergies, and actual medication use may reduce omissions, duplications, and other discrepancies. Pharmacist-led or multidisciplinary reconciliation may further strengthen the accuracy of medication information and improve communication among healthcare professionals. Accurate medication lists may support safer prescribing, reduce preventable medication errors, improve continuity of care, and strengthen patient safety during admission, transfer, and discharge. However, inadequate staffing, limited pharmacist involvement, incomplete patient records, poor documentation practices, time constraints, limited access to previous medication information, language or communication barriers, and fragmented health information systems may reduce the effectiveness of medication reconciliation services. The study therefore expects systematic, multidisciplinary, adequately documented, and consistently implemented medication reconciliation services to contribute significantly to improved medication list accuracy in Nigerian hospitals. The study is expected to contribute to the literature on medication reconciliation, medication safety, medication errors, patient safety, pharmaceutical care, healthcare quality, clinical documentation, and hospital practice in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management boards, public and private hospitals, pharmacists, physicians, nurses, medical records personnel, patient-safety committees, health information technology providers, development partners, and policymakers regarding strategies for improving medication safety. The study will also provide evidence-based recommendations for integrating medication reconciliation into routine hospital practice, strengthening pharmacist involvement, standardizing medication history and reconciliation procedures, improving health information systems, enhancing staff training, and establishing reliable medication documentation processes across Nigerian hospitals.

Keywords: Medication reconciliation services, medication list accuracy, medication discrepancies, medication errors, patient safety, pharmaceutical care, medication history, hospital care, healthcare quality, Nigeria, public health.