Objective:

To detect medication reconciliation errors (MRE) in adult patients attending the Adults Guard Service of a private third-level hospital; describe their basic medication and determine the potential severity of the discrepancies found.

Methods:

An observational, descriptive and prospective study was carried out. The medication of patients older than 18 years admitted in the adults guard service was relieved, through direct and indirect anamnesis. Subsequently, it was compared with the new prescriptions in order to detect possible discrepancies. The types of discrepancies and their potential severity were classified according to the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP).

Results:

100 patients were reconciled, of which 71% presented MRE, with a mean of 1.8 MRE/patient. The total number of reconciled medications was 682, detecting 324 total discrepancies, 198 justified and 126 requiring clarification, which were considered reconciliation errors. Most of the MRE were due to medication omissions. In addition, 21 pharmacological interactions were identified, being 12 clinically relevant. Acceptance of interventions by treating physicians was 62%. The severity of the MRE could be included in categories A-D.

Conclusions:

The intervention of the pharmacist avoided potential MRE and highlights the lack of exhaustiveness in collecting information of the patient's home medication.

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