[Conciliation discrepancies at hospital discharge].

Area of Science:

• Clinical Pharmacy
• Patient Safety
• Medication Management

Context:

• Hospital discharge medication reconciliation is critical for patient safety.
• Non-justified medication discrepancies are frequently observed during this process.

Purpose:

• To evaluate and describe non-justified discrepancies in chronic medication during hospital discharge.
• To assess the impact and seriousness of medication reconciliation errors.

Summary:

• A quality study involving 434 patients found 249 reconciliation errors (0.57 per patient).
• Discrepancies occurred in 35.2% of patients, averaging 1.62 errors each.
• Omissions were the most common error type, with 30% of errors having potential for temporary harm or hospitalization.

Impact:

• Medication errors in pharmacotherapeutic history are frequent and potentially significant.
• Improved medication reconciliation, including pharmacist involvement and data access, can reduce error frequency.
• Addressing these errors is crucial for preventing adverse patient outcomes and healthcare utilization.