Patients' medication reconciliation in a university hospital

Abstract Medication reconciliation is a strategy to minimize medication errors at the transition points of care. This study aimed to demonstrate the effectiveness of medication reconciliation in identifying and resolving drug discrepancies in the admission of adult patients to a university hospital. The study was carried out in a 300-bed large general public hospital, in which a reconciled list was created between drugs prescribed at admission and those used at pre-admission, adapting prescriptions from the pharmacotherapeutic guidelines of the hospital studied and the patients' clinical conditions. One hundred seven patients were included, of which 67,3% were women, with a mean age of 56 years. Two hundred twenty-nine discrepancies were found in 92 patients; of these, 21.4% were unintentional in 31.8% of patients. The pharmacist performed 49 interventions, and 47 were accepted. Medication omission was the highest occurrence (63.2%), followed by a different dose (24.5%). Thirteen (26.5%) of the 49 unintentional discrepancies included high-alert medications according to ISMP Brazil classification. Medication reconciliation emerges as an important opportunity for the review of pharmacotherapy at transition points of care, based on the high number of unintentional discrepancies identified and resolved. During the drug reconciliation process, the interventions prevented the drugs from being misused or omitted during the patient's hospitalization and possibly after discharge.

Medication reconciliation as a strategy for preventing medication errors

ABSTRACT One of the current barriers proposed to avoid possible medication errors, and consequently harm to patients, is the medication reconciliation, a process in which drugs used by patients prior to hospitalization can be compared with those prescribed in the hospital. This study describes the results of a pharmacist based reconciliation conducted during six months in clinical units of a university hospital. Fourteen patients (23.33%) had some kind of problem related to medicine. The majority (80%) of medication errors were due to medication omission. Pharmaceutical interventions acceptance level was 90%. The results suggest that pharmacists based reconciliation can have a relevant role in preventing medication errors and adverse events. Moreover, the detailed interview, conducted by the pharmacist, is able to rescue important information regarding the use of drugs, allowing to avoid medications errors and patient injury.

RESUMO Uma das barreiras propostas para se evitar possíveis erros relacionados a medicamentos e, consequentemente, que danos acometam o paciente, é a reconciliação medicamentosa no ato da internação, processo no qual se comparam os medicamentos usados pelos pacientes previamente à internação com os prescritos no âmbito hospitalar. Este trabalho descreve os resultados de seis meses de um processo de reconciliação conduzido por farmacêutico em unidades clínicas de um hospital universitário. Quatorze pacientes (23.33%) tiveram algum tipo de problema relacionado ao uso de medicamentos. A maioria dos erros envolvendo medicamentos (80%) estava relacionada à omissão de medicamentos. As intervenções farmacêuticas tiveram 90% de aceitação pelos médicos. Os resultados sugerem que a atuação de farmacêuticos na reconciliação medicamentosa pode desempenhar papel relevante na prevenção de erros de medicamentos e eventos adversos. Além disso, a entrevista detalhada conduzida por um farmacêutico se mostrou capaz de resgatar informações importantes sobre o uso dos medicamentos, permitindo evitar erros e danos ao paciente.