Pharmacists' review of medicine during admission to hospital

INTERVENTION: Please note that the anticipated end date for this trial has been extended from 01/11/10 to 31/03/10. Intervention Group 1. Review and use of patient own drugs by clinical pharmacist. 2. Clinical pharmacist taking secondary medication history. 3. Medication review by clinical pharmacist. 4. Entry of proposed prescriptions in the electronic medication system by pharmacist, ready for approval by doctor. The intervention takes place on the day the patient is admitted, and the duration of the intervention is approximately 1.5 hours. Control Group Standard care with no pharmacist involvement There is no follow up examination, but re‐admission rates will be noted for 1 year post intervention. CONDITION: In‐hospital adverse drug events ; Not Applicable ; Other complications of surgical and medical care, not elsewhere classified PRIMARY OUTCOME: Number of patients with in‐hospital adverse drug events, detected by Adverse Drug Event Trigger Tool. SECONDARY OUTCOME: 1. Length of hospital stay; 2. Number of readmissions during the first year after admission; 3. Direct cost for the hospital INCLUSION CRITERIA: 1. Patients being admitted to an internal medicine ward 2. Age 18 years or more 3. Taking 4 types of medicine or more each day 4. Able to understand participant's information written in Danish