Medication reconciliation in orthopedic and neurological patients in a public hospital

Abstract

Objective: To evaluate the discrepancies found by the clinical pharmacy service during medication reconciliations in patients hospitalized for orthopedics and neurology in a university hospital. Methods: A cross-sectional, descriptive and retrospective study was carried out from January to June 2018 with the patients followed-up by the clinical pharmacy service (orthopedics and neurology). Data was collected through medical charts and pharmacotherapeutic follow-up forms. The differences between the list of medications that the patient was using at home and the prescription from the hospital was classified as a discrepancy (justified or unjustified). Medical acceptance of the pharmaceutical interventions was assessed. The medications involved in the discrepancies were classified according to the ATC classification in its 1st level. Descriptive statistics was performed using the Excel program and Pearson’s chi-square test. Results: Of the 939 medications used by the patients, 673 (71.7%) presented discrepancies and in 371 (55.1%), unjustified discrepancies were found. Of the 507 patients included in the study, 154 (30.4%) presented at least one medication error. In 96.8% of the cases, the pharmaceutical interventions were performed, and acceptability was 30.6%, avoiding 110 errors. Medication omission was the most common type of discrepancy and the medical group most frequently involved was the cardiovascular system. Conclusions: Medication errors in admission to the orthopedics and neurology sectors are frequent, but they can be identified and solved through medication reconciliation, with professional clinical pharmacists able to perform it, collaborating for the safety of the patients.