Medication reconciliation in admission hospitalization: retrospective study


  • Juliana DORNELES
  • Calize O. SANTOS
  • Lucélia H. LIMA
  • Carine R. BLATT



Objective: to quantify and describe the discrepancies found in medication reconciliation (MR) in patients at hospital admission. Methods: Retrospective study performed from September to November 2018, based on data from the MR of patients at hospital admission of a large hospital in the city of Porto Alegre / RS. MR was shared with nursing (collection of patient’s medication history) and pharmacy (comparison of medication list before and during hospitalization). The referred drugs were classify according to the Anatomic Therapeutic Chemical (ATC) classification in their first level and the discrepancies were classify according to intentionality (intentional and unintentional). Results: 81 patients submitted to MR, and 80% of them had some discrepancy. Of the 328 drugs evaluated, 44.8% presented discrepancies, totaling 147 discrepancies, being intentional (n= 97) and unintentional (n= 50). The omission of medication was the most frequent discrepancies (48.3%). After identify unintencional discrepancies 50% of drug were included in prescription. Cardiovascular drugs and digestive and metabolism drugs were the groups with the highest frequency of discrepancy. Conclusion: Since 80% of prescriptions on hospital admission had some discrepancy regarding the use of medication by patients before hospital admission, it is understood the importance of performing MR as a pharmaceutical service and with the objective of increasing patient safety regarding drug therapy.


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How to Cite

DORNELES J, SANTOS CO, LIMA LH, BLATT CR. Medication reconciliation in admission hospitalization: retrospective study. Rev Bras Farm Hosp Serv Saude [Internet]. 2020Jun.30 [cited 2024May18];11(2):397. Available from: