Abstract

MARMOL-RODRIGUEZ, José Antonio  and  RODRIGUEZ-CASAL, Mª del Pilar. Estudio clínico de conciliación de la medicación al ingreso hospitalario en pacientes de las áreas de medicina interna y cirugíaClinical study of medication reconciliation at hospital admission with patients in the areas of internal medicine and surgery. Ars Pharm [online]. 2015, vol.56, n.3, pp.141-148. ISSN 2340-9894.  https://dx.doi.org/10.4321/S2340-98942015000300002.

Objectives: Examine the degree of complexity of pharmacotherapy in chronic patients. Analyze the continuity of medication at hospital admission. Detect the number, nature and impact of medication errors. Evaluate the hospital reconciliation protocol and analyze the contribution of the pharmacist. Methodology: Patients in the areas of internal medicine and surgery were selected for a month. Sources consulted to elaborate the medication history were the medical history and listings of dispensing drugs in unit doses. 48 hours after admission, medication discrepancies and medication errors associated with them were evaluated. The current protocol was examined too. Results: A total of 60 patients were included with an average age of 62.5 ± 17.2 years and 2.7 ± 1.9 per patient chronic diseases. The number of regular medication and during admission per patient was 5.4 ± 2.8 and 6.0 ± 2.9 respectively. 33.5% of the discrepancies were not justified and the average of them per patient was 2.6 ± 2.5. 49.3% of the discrepancies showed potential harm. An average of 1.3 ± 1.9 discrepancies with potential associated harm reached each patient. The medication reconciliation protocol, with the contribution of the pharmacist, was qualified with 94 out of 100 points. Conclusions: Pharmacotherapy of chronic patients is complex in community and hospital services. There is a high number of unjustified discrepancies at admission. Medication reconciliation protocols must be reviewed to obtain quality standards and reduce medication errors. The pharmacist should collaborate in the protocol.

Keywords : Medication Reconciliation; Medication Errors; Clinical Protocol; Pharmaceutical Care.

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