Background Reconciliation is the process of assessing a listing of the patients’ previous medicines with the current prescription. Around 46% of medicines errors in hospitals are reconciliation errors.

Purpose To evaluate the effectiveness of a method of integrated medicines reconciliation in an electronic prescribing programme (EPP).

Materials and Methods Prospective study of 22 months.

Within 24 hours of admission, a nurse records the patient’s usual medicines in the EPP.

The programme requires the doctor, before prescribing, to review the recorded home medicines. The programme suggests reconciliation for each drug, and the doctor must indicate if he accepts it. The home medicine automatically goes to the hospital prescription if the doctor accepts the suggestion, or he can suspend the drug or accept the therapeutic interchange that the programme offers him.

In the case of a drug that is not available in the hospital or for which there is no therapeutic equivalent, the doctor must decide if he suspends it or if he asks the patient to bring it from his home, in which case the medicine is sent to the Pharmacy department to repackage and dispense through a unit dose system.

All hospital beds were included in the study (450).

Results About 65% of the patients were on drug treatment when they were admitted to hospital.

• The average number of drugs per patient was 3.5.

• Home medicines reconciliation at admission was performed in 95% of patients admitted.

• We found only 9.6% of discrepancies: of which 91.4% were justified. Of the unjustified discrepancies: 7% were due to mistakes in the record of the home medicine or unregistered drug, 1.4% home of medicines were suspended without justification and there were 0.2% unjustified duplications.

• Reconciliation at discharge was only performed in 20% of the patients, since the programme does not yet require the doctor to do it.

Conclusions The implementation of medicines reconciliation in the EPP ensures it is done and reduces the discrepancies to 9.6%.

No conflict of interest.