[An interdisciplinary approach to reconciling chronic medications on admission to Mora d'Ebre local hospital]

To reduce medication errors and prevent interactions and duplications using a Chronic Medication Reconciliation Program on patient admission. To create an updated reconciled medications by resolving discrepancies within 24 hours of admission to the ward. To ensure the necessary medication is given at the dose, route and at the correct intervals depending on the clinical situation of the patient.

Prospective observational, non-randomised and uncontrolled study during the period from October 2008 to March 2009 (both included) in a primary level local hospital, in which all patients admitted to the hospital who met the inclusion criteria had their chronic medication reconciled on hospital admission.

A total of 469 patients were included, with 3609 medications being reconciled, of which 2466 (68.33%) had discrepancies: 667 (27.0%) unjustified and 1799 (72.9%) justified. There were no discrepancies in 1143 (31.6%). The majority of unjustified discrepancies were prescription omissions in 662 (26.8%) and duplications in 5 (0.2%). On 640 (25.9%) occasions the error reached the patient without causing any harm, and only 4 (0.16%) required monitoring.

Using an interdisciplinary approach in the reconciliation of chronic medication, many medication errors have been detected and neutralised. Discrepancies have been resolved, neutralising omissions, interactions and duplications. Drugs with a low intrinsic pharmacological value were withdrawn, and the list of reconciled medications recorded in the clinical notes.