Medication Reconciliation during Admission at University Hospital

Abstract

INTRODUCTION: Medication reconciliation is the process of comparing the most accurate list of all medications that a patient is taking with the list of prescription drugs within the healthcare system while considering the patient’s allergies and history of side effects. 
 
 OBJECTIVES: To reconcile medication upon the patients’ admission to a university hospital in the municipality of Campo Grande, Mato Grosso do Sul, Brazil. 
 
 METHOD: A prospective, cross-sectional study was conducted between June 2018 and May 2019 at the medical clinic unit of an university hospital. Discrepancies observed between the prescription and the best possible medication history were classified as intentional discrepancy; undocumented intentional; and unintentional.
 
 RESULTS: A total of 1,134 discrepancies were found between home-based drugs and those prescribed upon admission to the MCU. Among the discrepancies, 815 (72%) were intentional, 89 (8%) were undocumented intentional, and 230 (20%) were unintentional. The number of consultation sources and the number of medicines in use at home showed significant correlation with the occurrence of unintentional discrepancies (p = 0.039 and p = 0.008, respectively). A total of 318 pharmaceutical interventions were performed, 230 related to unintended discrepancies. Of these, 138 (60%) interventions were not accepted. 
 
 CONCLUSION: The study verified the high frequency of drug omission, conferring treatment interruption and the need for pharmaceutical assistance of polymedicated patients.

Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: identified through medication reconciliation

“…In this study, patients' lack of knowledge (60.1%) was the most common cause of UMDs. This finding is supported by many previous studies [ 27 , 38 , 63 ]. Understanding proximal causes leading to medication discrepancies may help to orient the MedRec process and can direct where the emphasis should be targeted to avoid potential UMDs [ 64 ].…”

“…All 388 medications involved in UMDs required intervention by the prescribing physician. Some of UMDs needed more than one intervention, as in what was reported in many of the previous studies [ 23 , 27 , 38 ]. From 422 pharmacist interventions, most (78.90%) of them were accepted and resulted in a modification in the patient’s care.…”

“…This finding is consistent with the results reported from studies done in St. Paul’s hospital millennium medical college, Ethiopia (41.4%) [ 49 ]; Chicago, Illinois (35.9%) [ 21 ]; Saint-Antoine Hospital, Paris, France (42%) [ 24 ], and Dhahran, Saudi Arabia (37%) [ 19 ]. However, it is higher than the studies conducted at a university hospital in Harar, Eastern Ethiopia (32.2%) [ 28 ]; Eastern provinces of Saudi Arabia (23%) [ 17 ]; Paris, France (18.8%) [ 25 ]; Strasbourg, France (33.2%) [ 29 ], and a university hospital in Brazil (20%) [ 38 ]. On the contrary, the figure in our study is lower than the studies done in Beirut, Lebanon (46.1%) [ 27 ]; Spanish hospitals (49.5%) [ 18 ]; Jeddah, Saudi Arabia (48.3%) [ 26 ], and Kenyatta National Hospital, Kenya (63.2%) [ 48 ].…”

“…Taking multiple medications at home, having polypharmacy upon admission to a hospital, older age, being female, and frequent admission to a hospital in the past one year are among the frequently reported factors of UMD [ 18 , 27 , 35 – 38 ].…”

“…Most of the studies that quantified medication discrepancies were undertaken in high and middle-income countries [ 4 , 15 – 27 , 38 , 44 – 46 ]. However, to the best of the authors' literature review, there is only limited evidence in Africa [ 47 , 48 ].…”