**Abstract**

Pharmaceutical care is a patient-centred practice that strives to optimise patients 'outcomes. In tertiary institutions, pharmaceutical care plays an important role in managing complex medical conditions and ensuring medication safety. Patients who attend tertiary care institutions are admitted for various reasons, and some of the conditions that warrant admissions are medication related. Patients, especially geriatrics may experience adverse reactions and drug interactions issues due to the multiple drugs that they consume. Some patients may have adherence issues that can lead to the worsening of their medical conditions. These pharmaceutical issues can be uncovered during their stay as inpatients through a thorough medication review. Pharmacists can play a role in providing knowledge and educating patients to overcome their medication-related problems. Monitoring of these problems can be undertaken through home visits by conducting home medication reviews, and other behavioural aspects of patient care, such as self-care, can be discovered.

**Keywords:** medication review, adverse drug reactions, medication adherence, home medication review, self-care
