Medication reconciliation on admission

Objective: To evaluate a standard operating procedure for medication reconciliation on hospital admission. Method: An observational pilot study in patients admitted through the Emergency Service or for scheduled surgery. The interviews were conducted using a previously prepared, standardized questionnaire that included personal history and information on regular medication. The regular medication was compared with the medication prescribed on admission to identify any possible discrepancies. The discrepancies detected were classified according to the Documento de consenso sobre terminologia, clasificacion y evaluation de los programas de Conciliation de la Medication (Consensus document on terminology, classification and assessment of the medication reconciliation programmes). Results: A total of 113 patients were included. Of them, 46% (52) were taking regular medication and, of them 67.3% (35) were drugs that had to be reconciled in less than 4 hours. A total of 84.6% (44) of the patients presented discrepancies. Of them, 75% (33) were justified and 25% (11) required clarifications. The omission of medication was related primarily with an inappropriate discontinuation of the medication during the perioperative period. Conclusions: The need to implement chronic medication reconciliation upon hospital admission was demonstrated, and the proposed standard operating procedure was found to be a useful tool to that effect. The procedure enabled us to prevent discrepancies and, consequently, to avoid associated medication errors and potential harm to the patient