[Medicines reconciliation at hospital admission into an electronic prescribing program]

To describe and to analyse a new method of integrated medicines reconciliation in an electronic prescribing program results.

12-month, prospective, observational, non-randomized and uncontrolled study, in which all patients who were admitted, during that year, to a general hospital of 450 beds. The electronic prescribing program was used for medication reconciliation as a means to multidisciplinary approach (nurses, doctors, pharmacists). This reconciliation was done at the time of hospital admission and reconciliation errors were measured.

A total of 23 701 patients were included, with 53 920 medications being reconciled, of which 48 744 (90.4%) had no discrepancies and 5 176 (9.6%) had discrepancies: 4 731 (8.7%) justified and 445 (0.8%) not justified. The majority of unjustified discrepancies were due to the drugs in use at home not recorded well on the hospital admission record in 310 (69.7%), prescription omissions in 105 (23.6%) and duplications in 30 (6.7%). In any case the reconciliation errors reached patients.

Using an electronic prescribing program and an interdisciplinary approach in the reconciliation of chronic medication, medication reconciliation at the time of hospital admission is achieved in 98% of patients, showing medication errors only in 1.3% of patients.