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PRaCtiCe BRief
caregiver and relays these concerns to members of the patient's circle of care.
4. The community pharmacist monitors for
adverse effects and adherence to medication
changes. He or she may document possible
adverse effects after medication deprescribing.
The hospital pharmacist explains the rationale
of the medication changes and discusses possible anticipated adverse effects.
Although acquiring and disseminating a complete and accurate medication list is the basis for
providing safe and optimal medication therapy,
this essential step is sometimes overlooked by
pharmacists. Hospital pharmacists, when given
the opportunity, should proactively coordinate
communication among health care providers
encountered by the patient in various settings.
A high level of trust and interprofessional collaboration is required for this proposed multidisciplinary approach of medication reconciliation.
Nonetheless, the pharmacist's role in coordinating

medication reconciliation may serve as the first
step to establish such collaboration. As a catalyst
in exchanging patient information among members of the patient's circle of care, the pharmacist's
efforts in promoting informed clinical decisions
and in reducing medication errors would be
appreciated by all members. While pharmacists
may not have the resources and time to coordinate detailed medication reconciliation for every
patient, in patients with numerous health care
exposures that may alter their medication list, a
comprehensive medication reconciliation could
reduce harm and result in successful medication
deprescribing for the patient. The Winchester
District Memorial Hospital deprescribing team
is reaching out to community members and
physicians around Winchester to make sure
that deprescribing is available to outpatients as
well. Since the end of December 2018, we have
received several referrals from community physicians requesting admission of their overmedicated patients for deprescribing. ■

From Winchester District Memorial Hospital (Elbeddini), Winchester, Ontario, and the University of Waterloo, School of
Pharmacy (Zhang), Kitchener, Ontario. Contact AElbeddini@wdmh.on.ca.
Author Contributions: A. Elbeddini was the lead for the deprescribing project at Winchester District Memorial Hospital.
C. Zhang was a student completing a 2-month rotation and was exposed to the learning and implementation of deprescribing
algorithms. She also drafted the manuscript. Both authors approved the final version of the article.
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research,
authorship and/or publication of this article.
Funding: The authors received no financial support for the research, authorship and/or publication of this article.

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http://www.ismp-canada.org/ download/MedRec/Medrec_AC_English_GSK_V3.pdf http://www.ismp-canada.org/ download/MedRec/Medrec_AC_English_GSK_V3.pdf https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=E7102580B4C1120B45AE6A729C3CCA66?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=E7102580B4C1120B45AE6A729C3CCA66?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=E7102580B4C1120B45AE6A729C3CCA66?sequence=1 https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=E7102580B4C1120B45AE6A729C3CCA66?sequence=1

Canadian Pharmacists Journal - May/June 2019

Table of Contents for the Digital Edition of Canadian Pharmacists Journal - May/June 2019