Background Discrepancies between the usual medications of patients and the medications prescribed when patients are admitted to hospital could be associated with severe complications. Implementation of medication reconciliation at admission has been reported as a way to improve quality of care.

Purpose The aim of the study was to evaluate the feasibility and additional contribution of a retroactive medication reconciliation process at admission in an acute cardiology unit.

Material and methods Before any intervention, we included prospectively, in the first part of the study, 67 patients (mean age 64 years; 66% men). From the patient and/or family, retail pharmacist, doctor interviews, a senior and a pre-graduated pharmacist carefully collected the usual medications taken by the patient. These medications were compared with the actual medications prescribed during the hospital stay. The discrepancies were classified as justified or unjustified.

In the second part of the study, the physicians in the unit were educated on the medication reconciliation process. In addition, a pre-graduated pharmacist was in charge during this period to check and discuss with the physician any medication discrepancies. The clinical impact of this intervention was evaluated prospectively on another population of 141 patients (mean age 68 years; 64% men).

Results Medication reconciliation was feasible in all patients included in the study. The rate of medication discrepancies decreased dramatically from 33% in the first phase of the study to 14% after the educational intervention (p = 0.003).

In addition, during the second phase of the study, the pharmacist informed the physician of any medication discrepancies. Among the 20 patients with a medication discrepancy, thanks to the pharmacist the prescription was appropriately corrected in 16 (80%) patients.

Conclusion This study showed the feasibility of the medication reconciliation process in an acute cardiology unit. The rate of prescription errors was dramatically decreased after implementation of the process. Implementation of a medication reconciliation process could enhance quality of care.

References and/or Acknowledgements

1. World Health Organization. MEDREC Assuring medication accuracy at transitions in care: medication reconciliation. High 5s: action on patient safety getting started kit. 2010

References and/or AcknowledgementsNo conflict of interest.