[Conciliation discrepancies at hospital discharge]. / Discrepancias de conciliación en el momento del alta hospitalaria en una unidad médica de corta estancia.

OBJECTIVE: To evaluate and describe the non-justified discrepancies found on reconciling chronic medication prescribed to patients when discharged from hospital. Secondly, the impact of the reconciliation process is evaluated by assessing the seriousness of the discrepancies. DESIGN: Cality study. SETTING: Short Stay Medical Unit in Elda General Hospital, Alicante, Spain. PARTICIPANTS: All patients discharged were included. INTERVENTION: The medication that the patient was taking before admission was obtained by personal interview before being discharged. The discrepancies that were non-justifiable with the treatment on discharge and with the pharmacotherapeutic history were identified and modified, where necessary, after consulting with the doctor. MEDITIONS AND RESULTS: Of the 434 patients interviewed, 249 conciliation errors were detected, which was 0.57 discrepancies per treated patient. Among the 35.2% of patients who had conciliation errors, the mean number of discrepancies was 1.62. Of these errors, 153 (61.5%) were produced when being discharged, while 96 (38.5%) were errors of omission or commission in the pharmacotherapeutic history. Of all the discharge reports reviewed, 11% did not record information on the previous treatment of the patient. Omission was the main type of error, both in the history and on discharge. As regards the potential harm of the detected errors, 30% could have caused temporary harm or hospitalisation. CONCLUSION: Medication errors in the pharmacotherapeutic history at the time of being admitted are common and potentially significant if they are continued. Including the pharmacist in the medical team, along with being able to access data at the different care levels, could help to reduce the frequency of these errors.

Discrepancias de conciliación en el momento del alta hospitalaria en una unidad médica de corta estancia / Conciliation discrepancies at hospital discharge

Objetivo. Evaluar y describir las discrepanciasno justificadas encontradas al conciliar lamedicación crónica de los pacientes con lamedicación prescrita en el momento del altahospitalaria. En una segunda parte, se evaluóel impacto del proceso de conciliación y sevaloró la gravedad de las discrepancias.Diseño. Estudio de calidad.Emplazamiento. Unidad Médica de CortaEstancia del Hospital General de Elda,Alicante.Participantes. Pacientes dados de alta.Intervención. Tras realizar una entrevistapersonal previa al alta, se obtuvo lamedicación que tomaba el paciente antesdel ingreso. Un farmacéutico identificólas discrepancias no justificadas con eltratamiento en el momento del alta y conla historia farmacoterapéutica, y en los casosnecesarios se modificó tras consultarlo conel médico.Mediciones y resultados principales. Serealizaron intervenciones en 434 pacientes yse detectaron 249 errores de conciliación, loque supone 0,57 discrepancias por pacienteintervenido.Dentro del 35,2% de lospacientes que presentaron errores deconciliación, la media de discrepanciasfue de 1,62. De estos errores, 153 (61,5%)se produjeron en el momento del altahospitalaria, mientras que 96 (38,5%) fueronerrores de omisión o comisión en la historiafarmacoterapéutica. El 11% de los informesde alta revisados no recogían informaciónsobre el tratamiento previo del paciente. Eltipo de error mayoritario tanto en la historiacomo en el momento del alta fue el deomisión. Respecto al daño potencial de loserrores detectados, un 30% podría habercausado lesiones temporales o lahospitalización.Conclusión. Los errores de medicación en lahistoria farmacoterapéutica en el momentodel ingreso son comunes y potencialmenteimportantes si se mantienen en el tiempo.La incorporación del farmacéutico al equipomédico, así como la disponibilidad de accesoa datos de distintos niveles asistenciales,podrían contribuir a reducir la frecuenciade estos errores

Objective. To evaluate and describe the nonjustifieddiscrepancies found on reconcilingchronic medication prescribed to patientswhen discharged from hospital. Secondly,the impact of the reconciliation process isevaluated by assessing the seriousness of thediscrepancies.Design. Cality study.Setting. Short Stay Medical Unit in EldaGeneral Hospital, Alicante, Spain.Participants. All patients discharged wereincluded.Intervention. The medication that the patientwas taking before admission was obtained bypersonal interview before being discharged.The discrepancies that were non-justifiablewith the treatment on discharge and withthe pharmacotherapeutic history wereidentified and modified, where necessary,after consulting with the doctor.Meditions and results. Of the 434 patientsinterviewed, 249 conciliation errors weredetected, which was 0.57 discrepanciesper treated patient. Among the 35.2%of patients who had conciliation errors,the mean number of discrepancies was 1.62.Of these errors, 153 (61.5%) were producedwhen being discharged, while 96 (38.5%)were errors of omission or commission inthe pharmacotherapeutic history. Of all thedischarge reports reviewed, 11% did notrecord information on the previous treatmentof the patient. Omission was the main type oferror, both in the history and on discharge.As regards the potential harm of thedetected errors, 30% could have causedtemporary harm or hospitalisation.Conclusion. Medication errors in thepharmacotherapeutic history at the time ofbeing admitted are common and potentiallysignificant if they are continued. Includingthe pharmacist in the medical team, alongwith being able to access data at the differentcare levels, could help to reduce thefrequency of these errors