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General and Risk Management, Patient Safety (including: medication errors, quality control)
Implementation of medicines reconciliation at hospital admission†
  1. L. González-García,
  2. S. Belda-Rustarazo,
  3. M.A. García-Lirola,
  4. C. Fernández-López,
  5. J. Cabeza-Barrera
  1. 1Hospital Universitario San Cecilio, Pharmacy, Granada, Spain
  2. 2Distrito Sanitario Granada, Pharmacy, Granada, Spain


Background Medicines reconciliation processes have successfully reduced drug errors and adverse drug events. In a recent project in the Traumatology ward of our hospital, 59.3% of the patients had at least one unintended medicines discrepancy. Based on this experience The authors decided to implement medicines reconciliation (MR).

Purpose To determine the number and type of pharmaceutical interventions performed after the implementation of the program.

Materials and methods A prospective study carried out between October 2010-October 2011 in a tertiary care teaching hospital. All patients admitted to surgical wards were included. The authors excluded those who could not be interviewed due to language problems and those who were admitted at the weekend. The methodology used in the MR process is the following: within the 24 h of the patient's admission, the pharmacist obtains the preadmission chronic treatment by interviewing the patient or the patient's family/care giver, or from the patient's medical chart and primary care records. This is compared with the treatment prescribed in hospital. All of the discrepancies detected (dose, regimen, route of administration or omission) are discussed with the attending physician to determine whether it was intended in accordance with the patient's condition. If the discrepancy is unintended, appropriate changes are made to the medicines.

Results Upon the implementation of MR, reconciliation was performed for a total of 1464 patients. The wards involved were: General Surgery (637), Traumatology (548), Urology (262) and Vascular Surgery (17). 1390 pharmaceutical interventions were performed, the most frequent being substitution for therapeutic equivalent (34.4%), adjustment of dose for renal insufficiency (24%), change to oral route (9.9%), omission of medicine (7.5%) or duration of treatment (5.5%), among others. The acceptance rate for our interventions was 91%.

Conclusions An MR system was developed with the aim of continuity of treatment at each transition of care and preventing medicines errors.

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