Background Medication reconciliation is a process to identify and solve unintended medicine discrepancies, defined as differences between the home treatment prescription and the first hospital prescription.
A large number of studies show that the reconciliation process minimises reconciliation errors (RE).
Purpose To determine the incidence of RE in polymedicated elderly patients admitted to an Emergency Department (ED) and to analyse the type of RE, drug group involved and severity of the RE.
Material and methods A prospective, 2 year intervention study, starting in February 2016.
The medication was reconciled in the first 24 hour after admission to the ED. Patients older than 65 years and six or more drugs were included.
The reconciliation was done by interviewing patients or carers in the ED and by consulting clinical and prescribing records.
A chronic medication list was collected. 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.
Variables collected were: age, sex, drugs prescribed, unjustified discrepancies, potentially inappropriate drugs, interactions and medication-related problems, RE and severity of RE.
Results Reconciliation in the admission to the ED was done with 553 patients, mean age 86 years (65–99), 68% females and 6027 drugs were reconciled (mean 10.9). There were 1050 unjustified discrepancies at admission, 326 potentially inappropriate drugs, 192 interactions and 118 medication-related problems, and 72 RE (average of 0.13 RE per patient).
The most common RE was omission of drugs (81%) followed by different dose, regimen or route (14%). According to the Anatomical Therapeutic Chemical Classification, the main groups involved in the RE were benzodiazepines with 36% of the RE, HMG Co-A reductase inhibitors (11%), cardioselective beta blockers (7%), proton pump inhibitors (4%), antidepressants selective serotonin reuptake inhibitors (3%), and insulins and analogues (3%). Regarding the severity of errors, 100% reached the patient without damage (severity C).
Conclusion Medication reconciliation by a pharmacist in the ED is an effective procedure to identify and resolve medication errors.
References and/or acknowledgements No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.