Background Inpatient safety studies show that medication errors are the leading cause of adverse health-related events. A high percentage of these errors occur during care transitions.
Medication reconciliation is an important strategy in reducing medication errors, whenever pharmacological treatments must be reviewed within the first 24 to 48 hours after admission, which is a key point in improving patients’ safety.
Purpose Implement a new circuit of medication reconciliation in geriatric patients to reduce medication errors during care transitions.
Material and methods A prospective, 1 year intervention study, starting in February 2016.
The medication was reconciled at two different times: in the admission to the Emergency Department (ED) and in the Geriatrics Department. Patients older than 65 years and six or more drugs admitted to the Geriatrics Department were included. The reconciliation was done by interviewing patients or carers in the the ED, medical records check and GP prescription. The discrepancies detected were collected and resolved each time the medication was reconciled, the reconciliation errors were quantified and a reconciliation report was made prior to admission to the Geriatrics Department.
A database was designed to generate automatic reports to accelerate the process and to make it easier for the practitioner to access the patient’s entire pharmacotherapeutic history before entering the ward, a key point in the circuit to improve the safety during the following intrahospitalary transitions.
Results Reconciliation in the admission to the ED was done with a report to 288 patients (mean age 82.8 years), of which the circuit was completed in 197 (68.4%) with admission to the Geriatrics Department and validation of treatment at the ward.
A total of 3371 drugs were reconciled in the ED (mean 11.7) and 2151 in the Geriatrics Department. There were 837 discrepancies at admission, of which 736 (87.9%) were not justified, 284 potentially inappropriate drugs were found (87.4% accepted), 173 relevant interactions (94.3% performance) and 72 problems related to the drug itself (86.4% performance). In the Geriatrics Department, 223 unjustified discrepancies were found, of which 47 were recognised reconciliation errors (severity C).
Conclusion The availability of the reconciliation report prior to admission to the Geriatrics Department improves work and reduces reconciliation errors, compared to data available from previous studies.
The automatic report is the most remarkable innovation that has accelerated and standardised the process.
No conflict of interest
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