Medication Reconciliation: Audit to an Internal Medicine Ward

Abstract

Introduction: Ageing population is characterized by multiple
comorbidities, polypharmacy and medication safety vulnerability. Medication discrepancies, together with the inexistence of
medication reconciliation procedures that implement National
Health Department recommendations, lead to negative consequences as drug interactions, healthcare non-programmed admissions and to geriatric syndromes.
Materials and Methods: The authors audited the prevalence
of medication reconciliation at discharge, analysing the pharmacological record and identifying discrepancies and errors
of medication. As a secondary endpoint, inward patients were
characterized. Data was collected through computer record
consultation as well as through patient or caregiver interview.
Results: Median of age was 78 years and half of patients
were totally dependent. There was a 3.9 average of comorbidities, medication reconciliation was present in 47% and in 61%
there was at least one medication discrepancy or error. The
medication error most frequently encountered was the introduction error.
Discussion and Conclusion: The high prevalence of medication discrepancies and of non- medication reconciliation is in
part due to the inexistence of a systematic process for collecting pharmacological history, poor doctor-patient communication and the lack of medication reconciliation procedure. The
higher prevalence of introduction errors may be due to copy
paste of previous and out of date pharmacological records.
There is a need for prospective studies that evaluate the medication reconciliation influencing factors, the medication errors
and its short and long-term consequences.