Background and Importance Medication Reconciliation (MR) allows us to reduce medication errors that are very likely to occur in care transitions like admission, transfer and clinical discharge. In our country, a few hospital institutions have MR, although the effectiveness of this method and Pharmaceutical Interventions (PI) in preventing adverse reactions, drug interactions and prescription errors. is known.

Aim and Objectives Establishing MR for patients at a vascular surgery department, in a tertiary care university hospital, to evaluate its impact in prescription error prevention and to characterise PI and its acceptance in our centre.

Material and Methods MR applied in the first 48 hours of patient admissions between April 2023 and September 2023. Inclusion criteria: age ≥ 35 years, presence of comorbidities and pharmacotherapy with ≥ 3 drugs. Elaboration of Best Possible Medication History (BPMH) taking ≥ 3 sources of information into account, comparison with medical prescription for identification and classification of discrepancies. Discussion of PI with prescribers, data recording and analysis using Microsoft Excel.

Results Of 210 patients (77.4% male), 16 were excluded for intervention rescheduling, sudden clinical discharge or transfer between departments. Medium age was 70.7 years [range 35; 92] and we found a medium of 4.7 comorbidities per patient as hypertension, dyslipidaemia and diabetes were the most prevalent. For BPMH gathering, medical records (28.8%), patient interview (25.0%) and drug packaging (20.2%) were the most used sources of information. In 202 MR, 3,010 prescription lines were analysed and 77.5% of them contained discrepancies. Of those, 31.5% were unintentional with potential to cause harm to patients. A total of 761 PI were made with 89.1% acceptance by prescribers, mostly for drugs with cardiovascular (32.5%), central nervous system (18.8%) and endocrine (13.9%) action. Drug omission was the most frequent medication error (62.8%), followed by erroneous dose (16.9%) and erroneous drug (6.1%). It was detected 348 pharmacological interactions and 37 adverse events with independent PI, whenever patient harm was considered.

Conclusion and Relevance MR allowed us to reduce and prevent a major number of medication errors, as almost 90% of PI were accepted by physicians. This method should be implemented in most susceptible hospital departments, as a clinical pharmacist presence benefits all of the healthcare team, the patient and medication safety.

Conflict of Interest No conflict of interest.