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Pharmacy has evolved over several centuries from the traditional role of dispensing and compounding a physician's order, to include modern day services, such as patient care. The underlying philosophy of clinical pharmacy is pharmaceutical care. This is a patientcentred approach which addresses all possible pharmaceutical interventions in the context of a fully integrated multidisciplinary plan of care. The most effective pharmaceutical care is achieved when pharmacists become part of the clinical team caring for patients. Clinical pharmacists are not currently part of ward staff in South Africa, as seen in the USA or the UK. This may be because of human resources and an inadequate number of trained clinical pharmacists. This has an impact on the effectiveness of the pharmacist, as he or she should be based in the wards so as to become an effective member of the healthcare team. A high-impact unit that would benefit greatly from pharmaceutical care is the neonatal intensive care unit, which has been shown to be highly vulnerable to medication errors, and in which a clinical pharmacist could play a role in decreasing medication errors. [ABSTRACT FROM AUTHOR]

Adverse drug events (ADEs) have been found to be a major cause of morbidity and mortality in healthcare systems around the world. More than 50% of ADEs are preventable, and have been demonstrated to be the result of an incomplete medication history, prescribing or dispensing error, and the over- or underuse of prescribed pharmacotherapy. The main aim of implementing medication reconciliation in a hospital setting is to avoid ADEs, a prevalent patient safety issue. Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking, including drug name, dosage, frequency and route, and then comparing that list against the admission, transfer, and/or discharge orders. Medication reconciliation is one of World Health Organization's High 5s initiative to improve patient safety. The implementation of the International Standard Operating Procedure for Medication Reconciliation led to a 50% reduction in medication discrepancies in developed countries. Implementing the medication reconciliation in the hospitals of South Africa may reduce medication errors. [ABSTRACT FROM AUTHOR]