Medication reconciliation: a prospective study in an internal medicine unit

Area of Science:

• Clinical Pharmacy
• Patient Safety
• Internal Medicine

Background:

• Medication reconciliation is a proven method for enhancing drug-prescription safety.
• Incomplete or inaccurate patient medication histories are a common challenge in healthcare settings.

Purpose of the Study:

• To evaluate an intervention designed to reduce discrepancies between patients' usual medications and those prescribed upon admission.
• To assess the impact of this intervention on medication safety in a specific patient population.

Main Methods:

• Prospective study conducted over six months (November 2010 - May 2011).
• Analysis of discrepancies between home medications and prescribed drugs for patients aged 65 years and older.
• Patients were transferred from the Emergency Department and admitted to the Internal Medicine Unit.

Main Results:

• 170 patients and 1,515 medications were included in the reconciliation process.
• The unintentional discrepancy rate decreased from 4.3% to 0.9% following the intervention.
• Key sources of discrepancies involved drugs for the alimentary tract/metabolism (25.7%), cardiovascular system (24%), and nervous system (19.4%).

Conclusions:

• Patient medication history acquisition is frequently incomplete or inaccurate.
• Pharmacists are well-positioned to assist medical teams in correcting medication discrepancies.
• Further assessment of the cost-effectiveness of this intervention is warranted.