# Challenges in implementing pharmacist-led admission medication reconciliation in hospital practice: a qualitative study

## TL;DR

This study explores why pharmacist-led medication reconciliation is not widely implemented in hospitals, identifying key barriers like time constraints and lack of feedback.

## Contribution

The study provides a structured analysis of barriers and facilitators to implementing pharmacist-led admission medication reconciliation using the PRECEDE-PROCEED model.

## Key findings

- Pharmacists recognize the value of admission MedRec but deprioritize it due to time constraints.
- Lack of performance feedback and unclear institutional norms hinder implementation.
- Professional training gaps and limited information system support are significant barriers.

## Abstract

Pharmacist-led admission medication reconciliation (MedRec) plays a critical role in optimizing pharmacotherapy during care transitions. Despite its benefits are well established, real-world implementation remains limited. To address this gap, this study explored context-specific barriers and facilitators affecting admission MedRec implementation in a hospital setting.

This narrative qualitative study used semi-structured interviews to explore factors influencing the implementation of pharmacist-led admission MedRec at a medical center in Taiwan. Fifteen pharmacists with admission MedRec experience and varying seniority levels were purposively recruited for face-to-face interviews. The interview guide was developed using the PRECEDE-PROCEED model and covered predisposing, enabling, and reinforcing factors, as well as physical and social environmental influences. All interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Although coding was conducted inductively, the resulting themes were subsequently organized within the PRECEDE-PROCEED framework.

Five overarching themes were identified. Predisposing factors reflected pharmacists’ positive views of admission MedRec but noted challenges with prioritizing it in daily practice. Reinforcing factors pointed to a lack of performance feedback and limited external recognition. Enabling factors highlighted gaps in professional competencies and insufficient training opportunities. Physical and social environmental barriers, including limited information system support, frequent workflow interruptions, and unclear institutional norms, further impeded implementation.

Major barriers to implementing pharmacist-led admission MedRec included time constraints, unclear prioritization, and inadequate feedback mechanisms. While pharmacists recognized the value of admission MedRec, it was frequently deprioritized during routine practice. Using the PRECEDE-PROCEED model facilitated a structured assessment of individual and contextual determinants. These findings provide practical direction for developing targeted strategies to support and sustain admission MedRec implementation in hospital settings.