Medication reconciliation at hospital admission and discharge in an orthopedic surgery and traumatology department

Abstract Purpose To evaluate the results of a medication compatibility and drug information programme at discharge in an orthopaedic surgery and traumatology department. Materials and methods Patients with more complexity in their home treatment, admitted in this facility during 2008 were included in the study. Preadmission regimens were recorded and the patents were asked about medication-related problems (PRM) and drug adherence. On the day of discharge, prescribed medication was reconciled with the outpatient treatment, resolving discrepancies with the prescribers. Finally, the patients were given a complete list of their medications after the care episode and recommendations on their treatment with oral explanation. We conducted a survey of the physicians to ask about their compatibility programme knowledge and their assessment. Results 243 patients were selected, in whom 102 (42%) PRMs were detected. The major discrepancies were found in antithrombotic drugs (25%) and analgesics and anti-inflammatory drugs (21%). The most frequent were: therapeutic duplication (53%) and interactions (27%). The PRMs were classified according to their severity: 65% would not have caused harm to the patient and 35% would require monitoring. Regarding the survey, the overall evaluation of the programme was “very good” for 100% of the physicians. Discussions Medication compatibility has proved to be a useful strategy for improving the safety of our patients as part of a system to reduce health risks and improving quality of care.