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Background and Importance Medication reconciliation (MR) is a crucial safety strategy to prevent medication discrepancies during transitions of care. Delays and incomplete MR can lead to preventable harm. Digital tools, such as PharMS, have been developed to support pharmacists in performing MR more efficiently.Aim and Objectives To evaluate MR outcomes with PharMS during a full fiscal year (October 2024 – September 2025), focusing on timeliness, discrepancy detection, and patient safety.Material and Methods A retrospective observational study was conducted, encompassing all inpatients who underwent MR during the study period. The primary outcome was the proportion of MRs completed within 24 hours of admission. Secondary outcomes included MR processing time, number and type of discrepancies detected, the proportion of preventable errors resolved, and severity of errors based on NCC MERP categories. Descriptive statistics with 95% confidence intervals were reported, and proportions were compared with the previous year where relevant.Results A total of 18,288 patients underwent MR.Timeliness: 90.6% (16,551/18,288) of patients received MR within 24 hours (95% CI: 90.2–90.9%), exceeding the 80% target. Average MR completion time was 56 minutes, a 32% reduction compared with baseline, while the PharMS–assisted digital comparison step required 27 seconds on average (57% reduction).Discrepancies: Pharmacists detected 120 discrepancies, most frequently duplication (40.7%; 95% CI: 31.5–49.9%) and omission (37.0%; 95% CI: 28.7–45.7%).Error prevention: 90.0% (108/120; 95% CI: 83.2–94.7%) of discrepancies were prevented or resolved. This represented a significant increase compared to the previous year (71.4%; z = 3.11, p = 0.0019).Patient safety: Most discrepancies were intercepted before reaching patients (NCC MERP level B). Only two cases (0.011%) resulted in level E harm, both related to warfarin, corresponding to an incidence of ~1.1 per 10,000 MR cases (95% CI: 0.13–3.9).Conclusion and Relevance PharMS-supported MR in 2025 achieved high timeliness, improved efficiency, and enhanced detection of discrepancies, with a significantly higher proportion of preventable errors resolved. Serious harm events were infrequent. These findings demonstrate the impact of digital support systems in strengthening medication safety and ensuring timely MR in hospital practice.Conflict of Interest No conflict of interest