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PS-033 Preventing medicines errors by medicines reconciliation at admission and discharge
  1. M Hernández Segurado,
  2. FJ Bécares Martínez,
  3. M Bonilla Porras,
  4. MÁ Arias Moya,
  5. EM Martín Gozalo,
  6. M Forte Pérez-Minayo,
  7. P Pelegrin Torres,
  8. E Castillo Bazán,
  9. MI Panadero Esteban,
  10. G Toledano Mayoral
  1. University Hospital Fundación Jiménez Díaz, Pharmacy Service, Madrid, Spain


Background Institutions related to healthcare quality, such as the Joint Commission, recognise that reconciliation errors (REs) compromise the safe use of medicines.

Purpose To prevent medicines errors by reconciling the patient’s current medicines (CM) at admission and discharge, quantify and analyse the discrepancies found between the CM and those prescribed and to identify the possible causes of RE.

Material and methods A prospective observational study was conducted from May to July 2014, in which patients over 75 years with 6 or more usual drugs were included. The process of medicines reconciliation was conducted by interviewing the patient, reading the primary care electronic medical record, background checks, last admission and outpatient visits. Updated CM was recorded in the hospital electronic medical record system and was compared with the drugs prescribed on admission and at discharge.

Results 295 patients were reconciled: 3,205 medicines (average of 10.8 drugs per patient). 238 patients (80.3%) at admission (28 patients were excluded) where 1,020 discrepancies were detected, of which 353 (34.6%) were REs: 29% drug omission, 3% dosage or regimen error, 1% wrong drug and 1% drug prescribing previously concluded. 51% of patients had at least 1 RE, and 32.9% more than 1 RE. 57 patients (19.7%) were reconciled at discharge, all reconciled at admission. 69 discrepancies were detected of which 9 (13%) were reconciliation errors: 2% drug omission, 4% dosage or regimen error, 1% wrong drug and 6% drug prescribing previously concluded. 8.7% of patients had at least 1 RE and 5.2% more than 1 RE.

Conclusion Medicines reconciliation at admission and discharge prevents medicines errors, thus increasing patient safety. Key points to avoiding errors were detected: update the record in the electronic medical record of the patient’s CM at admission, and correctly reconcile CM at admission to prevent errors at discharge.

References and/or acknowledgements No conflict of interest.

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