[31,35,45,47] Of concern is research that has indicated that medication administration errors and near-miss incidents in the hospital setting are common.[19] Another area of concern is that medication dosage forms are often modified, for example

crushed and mixed into food or beverage, to aid medication administration, and nursing staff may not be aware of the potential clinical effect of these alterations.[49,50] Pharmacists play a major role in providing drug information in relation to medication administration and educating healthcare providers about problems resulting from altering medication dosage forms.[19,30,49,50] Pharmacists see more can also be involved in extemporaneous preparations to compound or manufacture dosage forms that are not commercially available and to ensure check details safe administration of the medication.[19,50] This, again, raises the importance of medication support systems for rural healthcare providers in non-pharmacist sites, as highlighted above in previous steps. Following administration or supply of medication, healthcare providers, carers and patients themselves have the responsibility to monitor the patient’s response (positive and/or negative) to a given medication.[2] Generally, any medications administered by a healthcare

provider (e.g. nursing staff) are closely monitored for effectiveness and adverse reactions at the facility where the administration occurred.[30,35] The extent of such monitoring may differ between healthcare providers and between workplaces. Pharmacist-mediated medication review services have been demonstrated as valuable in enhancing the management of patients’ medications.[23,25,26,41,51] Established services include Home Medicines Reviews (HMRs) and Residential Medication Management Reviews (RMMRs), which allow accredited pharmacists to Phosphatidylethanolamine N-methyltransferase provide detailed medication review services to patients

using multiple medications at the patient’s home (HMR) or aged-care facility (RMMR).[23,28,41] This not only incorporates monitoring of patients’ responses to their medication regimen, but also involves other components of the medication pathway such as review of prescribing, provision of medication information to the patient, transfer of information/recommendation(s) to the general practitioner (GP), and finally, the GP developing a management plan based on the pharmacist’s recommendation(s).[23,25,41] A similar medication review service for post-discharge patients has been proposed and the hospital referral pathway is currently being explored.[19,26] Available studies on pharmacist-mediated medication review services were focused in metropolitan areas; remuneration, workforce issues and ‘territorial issues’ with local GPs have been cited as barriers to the service.