Background and Importance Medication reconciliation (MR) is a pharmaceutical activity that aims to resolve errors that occur in the continuation of chronic treatment at the transition among different levels of Healthcare Systems and that increase patient morbidity and mortality.

Aim and Objectives To analyse the MR activity on admission by the Pharmacy Service of a second level hospital to determine its usefulness as a method for preventing medication errors.

Material and Methods Retrospective descriptive observational study (January 2022-July 2022) of the pharmaceutical interventions (PI) reviewed in relation to MR. The variables studied were: clinical service, pharmacotherapeutic group, type of error and acceptance. We used the programme of electronic medical record MambrinoXXI® for reviewing chronic treatments and the pharmaceutical validation programme Farmatools®.

Results In this period of time, 12.946 admissions were validated and 658 PI about MR were performed on a total of 516 patients. The clinical services with more PI were: Internal Medicine (N=287, 43.62%), General and Digestive Surgery (N=78, 11.85%), Digestive (N=57, 8.66%) and Neurology (N=40, 6.08%). The most frequent type of reconciliation error was: omission (N=523, 79.48%), followed by change of dosage regimen (N=114, 17.33%). The pharmacotherapeutic groups with most PI were: lipid-lowering agents (N=75, 11.40%), antihypertensives (N=69, 10.49%), antidepressants (N=66, 10.03%), urological drugs (N=53, 8.06%) and inhaled antiasthmatics (N=30, 4.56%). The acceptance rate was: 43.92% (N=289), 24.31% non-accepted (N=160) and 31.76% non-evaluable (N=209). Excluding non-evaluable results, the acceptance rate was 64.37%.

Conclusion and Relevance Although less than half of the PI were accepted, the role of the pharmacist in MR is useful. This activity could be optimised by the presence of the pharmacist both in the emergency department and on the hospitalation unit, as well as by implementing actions such as patient interviews. The detection of the main clinical services and pharmacological groups requiring this type of intervention would make it possible to prioritise MR criteria and create protocols in order to improve the patient safety and reduce the proportion of non-evaluable results.

Conflict of Interest No conflict of interest