Objective To discuss the effects and practice of medication reconciliation performed by clinical pharmacists on preventing medication errors. Methods The effect of medication reconciliation on preventing medica-tion errors was analyzed based on specific cases. Results Medication reconciliation can reduce the medication errors, such as omissions or duplications,incorrect doses or usage,incorrect drug selection,not timely withdrawal,incoherence to therapeutic drug monitoring and drug interactions. Conclusion It is important to perform medication reconciliation to reduce the medication errors. The development of medication reconciliation provides a new work style for clinical pharmacists.%目的 探讨临床药师开展药物重整服务在防范用药差错中的作用与实践. 方法 结合具体临床案例分析药物重整中发现的常见问题及其在防范用药差错中的作用. 结果 药物重整可减少发生药物遗漏或重复给药、用法用量不适宜、药物选择不适宜、停药不及时、血药浓度监测不连贯、药物相互作用等现象. 结论药物重整服务在减少用药差错中具有重要作用,为临床药师参与临床提供了一种新的方式.
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