[Medication reconciliation: From admission to primary care]

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Clinical pharmacy practice

Background:

• Medication errors are a significant patient safety concern.
• Effective medication reconciliation is crucial for preventing adverse drug events.
• Integrated health organizations require coordinated approaches to medication management.

Purpose of the Study:

• To implement a multidisciplinary medication reconciliation process across different healthcare levels.
• To quantify medication discrepancies at admission, discharge, and primary care transitions.
• To evaluate the impact of reconciliation on communication and safety culture.

Main Methods:

• Prospective intervention study over one year.
• Medication reconciliation performed at hospital admission, discharge, and primary care visits.
• Systematic collection and resolution of medication discrepancies, quantifying drug counts before and after.

Main Results:

• 77 patients (63% male, mean age 69.5 years) were included.
• Mean discrepancies per patient: 7.85 at admission, 3.67 at discharge, 2.19 at primary care.
• The program successfully detected and resolved medication discrepancies.

Conclusions:

• The medication reconciliation program effectively reduced medication errors.
• It fostered improved communication among healthcare professionals.
• The initiative promoted a stronger safety culture within the organization.