[Translated article] Medication reconciliation in hospitalized haematological patients

The main objective is to analyse unjustified discrepancies found during the medication reconciliation process in patients admitted to the Haematology Service of our hospital, in addition to the pharmaceutical interventions carried out. As a secondary objective, to detect possible points of the procedure to be perfected with a view to protocolizing the medication reconciliation process in haematological patients that adapts to the conditions of our center.

Cross-sectional observational pilot study carried out in a reference hospital in haematology for a population of 800 000 inhabitants. Adult inpatients admitted to the Haematology Service between August and October 2022 whose medication had been reconciled were included. The main variables were: number and type of unjustified discrepancy, proposed pharmaceutical intervention, and degree of acceptance.

36 conciliation processes were analysed, 34 admissions and 2 intrahospital transfer. 58.3% of the patients presented some unjustified discrepancy. 38 unjustified discrepancies were detected, with an acceptance of pharmaceutical interventions of 97.4%. The most common types of discrepancy were medication omission (56.8%) and drug interaction (24.3%). The most frequent pharmaceutical interventions were reintroducing medication (48.6%) and suspending treatment (16.2%). Polypharmacy and receiving chemotherapy treatment multiply by 4 the probability of presenting drug interactions.

The most common unjustified discrepancies in the medication reconciliation process in hospitalized haematology patients are: medication omission and drug interactions. The reintroduction of medication and suspension of the prescription are the most frequent accepted pharmaceutical interventions. Polypharmacy is related to an increase in unjustified discrepancies. The factors that promote the appearance of interactions are admissions to receive chemotherapy treatment and polypharmacy. The main point of improvement detected is the need to create a circuit that allows conciliation to be carried out on discharge. Medication reconciliation contribute to improving patient safety by reducing medication errors.