Background and importance The risk associated with contraindicated administration or omission of doses of a treatment is increased in the case of immunosuppressive drugs due to their narrow therapeutic margin, with small differences between therapeutic and toxic doses.

Aim and objectives The aim of this study was to investigate whether the immunosuppressive drugs prescribed to hospital inpatients is correct, and to emphasise the role of the pharmacist in medication conciliation.

Material and methods A prospective analytical study was performed in a second-level hospital for a period of 4 months. Every patient admitted who was being treated with immunosuppressive drugs was included.

Patients with immunosuppressant treatment were analysed and their medication was reconciled with the help of the Diraya digital history software and, in the case of discordance between their home medication and the prescribed medication, the prescribing physician was contacted. The variables collected were: demographic data, immunosuppressive treatment, hospital service, error type, intervention by the pharmacist and whether this was accepted by the physician.

Results A total of 34 patients were included in the study, with a mean age of 59±13 years (53% men). Of all the patients, 41% (14 patients) had errors in their immunosuppressive treatment regimen, and the pharmacist intervened in all of them. However, in 2 patients the intervention was not assessable since they were discharged on the same day of admission.

All errors occurred with the different types of tacrolimus and mycophenolate.

The emergency department was the worst at prescribing immunosuppressive drugs, with 8 patients (57%). The remaining patients were: 2 in vascular surgery, 2 in nephrology, 1 in pneumology and 1 in psychiatry.

In 9 patients (75%), the dose was incorrectly prescribed. In 2 other patients there were treatment omissions, and in another there was an error in prescribing the form of treatment release.

Most of the interventions performed by the pharmacy service were accepted by the physician (75%), modifying the immunosuppressive regimen.

Conclusion and relevance The conciliation process is aimed at detecting and correcting possible medication errors that may have gone unnoticed.

The importance of this process on the part of the pharmacist is enhanced with vitally important drugs such as immunosuppressive drugs, and in hospital services where the workload is heavy such as the emergency department.

Conflict of interest No conflict of interest