Wiener klinische Wochenschrift · 2026
Hospital seamless care beyond medication reconciliation: a 1-year evaluation in a Slovenian general hospital.
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Markoja Urška, Kovačič Alenka
Аннотация
OBJECTIVE: To evaluate a hospital seamless care service by characterizing medication discrepancies identified during medication reconciliation and documenting additional clinical pharmacy activities performed throughout hospitalization.
METHODS: A retrospective observational study was conducted at the General Hospital Murska Sobota, Slovenia. All hospital admissions in which the hospital seamless care service was completed between 1 January and 31 December 2025 were included. Patient characteristics, medication discrepancies identified at hospital admission and discharge, additional clinical pharmacy activities, discharge medication supply, and differences between medical and surgical departments were analyzed.
RESULTS: A total of 1813 seamless care episodes were included. At least one unintended medication discrepancy at hospital admission was identified in 391 episodes (21.6%), with medication omission being the most frequent discrepancy. At hospital discharge, the most common discrepancies were omitted medications in discharge summaries and missing prescriptions for newly initiated medications. Beyond medication reconciliation, at least one additional clinical pharmacy activity was documented in 341 episodes (18.8%). Seamless care episodes in medical departments included a significantly higher total number of clinical pharmacy activities within the seamless care service than those in surgical departments (p < 0.001). All prescribed discharge medications were supplied directly to patients in 439 seamless care episodes (24.2%).
CONCLUSION: Medication reconciliation alone does not fully capture the scope of hospital seamless care. A substantial proportion of seamless care episodes involved additional clinical pharmacy activities throughout hospitalization. Comprehensive documentation of clinical pharmacy activities can provide a more complete evaluation of seamless care services and facilitate benchmarking across hospitals.
METHODS: A retrospective observational study was conducted at the General Hospital Murska Sobota, Slovenia. All hospital admissions in which the hospital seamless care service was completed between 1 January and 31 December 2025 were included. Patient characteristics, medication discrepancies identified at hospital admission and discharge, additional clinical pharmacy activities, discharge medication supply, and differences between medical and surgical departments were analyzed.
RESULTS: A total of 1813 seamless care episodes were included. At least one unintended medication discrepancy at hospital admission was identified in 391 episodes (21.6%), with medication omission being the most frequent discrepancy. At hospital discharge, the most common discrepancies were omitted medications in discharge summaries and missing prescriptions for newly initiated medications. Beyond medication reconciliation, at least one additional clinical pharmacy activity was documented in 341 episodes (18.8%). Seamless care episodes in medical departments included a significantly higher total number of clinical pharmacy activities within the seamless care service than those in surgical departments (p < 0.001). All prescribed discharge medications were supplied directly to patients in 439 seamless care episodes (24.2%).
CONCLUSION: Medication reconciliation alone does not fully capture the scope of hospital seamless care. A substantial proportion of seamless care episodes involved additional clinical pharmacy activities throughout hospitalization. Comprehensive documentation of clinical pharmacy activities can provide a more complete evaluation of seamless care services and facilitate benchmarking across hospitals.