Background Transition between different healthcare settings is a risk factor for medication discrepancies in the patient’s medication list. A large number of discrepancies has the potential to cause adverse drug events.

Purpose Obtaining a complete medication list of a patient is very important to avoid unintentional medication discrepancies and medication related problems at admission. We aimed to evaluate the added value of a structured medication review in the emergency department by a pharmacy technician.

Material and methods Well trained pharmacy technicians performed a medication review of patients admitted to the emergency department by using a structured form and different sources (patient, family, medication list, family doctor, etc). The physician acquired medication list was compared with that acquired by the technician to identify unintentional discrepancies (any difference between the two medication lists). The clinical impact was evaluated by a multidisciplinary team of pharmacists and pharmacologists.

Results From February to April 2016, 279 (74.9%) medication discrepancies were identified in 113 medication lists. The most common discrepancies were omission of a drug (43.7%), omission of frequency (17.2%) and omission of dose (14.7%). Drugs belonging to the class of analgesics (21.1%) and obstructive airway disease (18%) were associated with the highest discrepancy rates. There was a positive association between the number of discrepancies and the number of drugs (p=0.002) and information sources (p=0.026) and the time needed to perform the reconciliation (p=0.001). 6.5% were evaluated as having a potentially very significant impact on the patient’s health; 30.6% were evaluated as having the potential to cause moderate clinical impact and 2.2% as potentially having a minor or no impact.

Conclusion This study provides evidence that structured medication review is useful to obtain a complete medication history, to avoid medication related problems and to guarantee the patient’s safety.

References and/or acknowledgements Mueller SK, et al. Arch Intern Med2012;172:1057–69.

No conflict of interest