Background Reconciliation errors (RE) represent a security problem and have been identified by organisations such as the Institute for Healthcare Improvement (IHI) and the Joint Commission on Accreditation of Healthcare Organisations (JCAHO) as a priority issue within security strategies for patients.

Purpose To determine the incidence of RE in polymedicated elderly patients admitted to a trauma service and to analyse the type of RE, drug group involved and severity of the RE.

Material and methods Prospective observational study conducted between June and September 2015, in which all patients aged 65 years or older on treatment with at least 5 drugs were included. Variables collected were: age, sex, drugs prescribed, RE and severity of RE. The information sources used were electronic clinical and prescribing records and patient interview. Patients were included in the first 24 h after admission. Chronic medication list was collected by consulting the information sources mentioned above. This list was compared with prescriptions performed during hospitalisation. In cases where a discrepancy that required clarification was found, it was discussed with the doctor. To classify a discrepancy as an RE, the prescriber had to accept it as such after seeking clarification.

Results 67 patients were included with a mean age of 69 years (29.7% men, 70.3% women). 577 drugs were reviewed, resulting in an average of 8.46 medications prescribed per patient with an average of 2.88 RE per patient. The most common RE was omission of drugs (74.09%) followed by different dose, regimen or route (6.14%). According to the Anatomical Therapeutic Chemical Classification level 4, the main groups involved in the RE were benzodiazepines with 15.03% of the RE, HMG Co-A reductase inhibitors (5.23%) and cardioselective beta blockers (4.58%).

Regarding the severity of errors, 73.21% reached the patient without damage, 14.59% reached the patient and required monitoring and 12.20% missed the patient. The recommendation made by the pharmacist was accepted in 81.3% of cases.

Conclusion The most common RE was drug omission. The pharmacist has a key role in collecting the best possible medication history from the patient to avoid these RE. Medication reconciliation emerges as an opportunity to establish the role of the pharmacist in the health system, to redefine the doctor-pharmacist-patient relationship and to improve the use of medicines and treatment outcomes.

No conflict of interest.