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Medication reconciliation: a prospective study in adult patients

Grant number: 13/06065-7
Support Opportunities:Scholarships in Brazil - Scientific Initiation
Effective date (Start): July 01, 2013
Effective date (End): June 30, 2014
Field of knowledge:Health Sciences - Pharmacy
Principal Investigator:Eliane Ribeiro
Grantee:Paula Baldan Zaccaro
Host Institution: Faculdade de Ciências Farmacêuticas (FCF). Universidade de São Paulo (USP). São Paulo , SP, Brazil


As the world population gets older, an increasing number of people present several comorbidities and use a variety of continuous-use prescribed medication. A large part of the population treated at the University Hospital of the University of São Paulo (HU-USP) has numerous comorbidities, and, consequently, takes many continuous- use drugs. Additionally, the high turnover due to reduced hospitalization time and frequent transfers between clinics can contribute to the occurrence of medication errors (ME).A review study showed that 67% of patients are subject to at least one ME arising from a discrepancy resulting from the comparison between their history of chronic-use drugs and their prescription at the time of admission. Moreover, Barnsteiner (2008) showed that 40% of ME detected in patients who experienced at least one error can be attributed to an inadequate collection of information during admission, transfer and / or discharge, which indicates the need for a systematic approach to ensure an accurate collection of patient medication history. Thus, in the context of safety and effectiveness of drug therapy, medication reconciliation is coupled with medication adherence as a process of comparison between the lists of medications taken by the patient aimed at preventing ME, such as omission, duplication, dosing errors and drug interactions. The practice of medical reconciliation requires a comprehensive and systematic review of all medications a patient is using, thus ensuring that the medicines being added, changed or discontinued are carefully evaluated in order to maintain an accurate and updated prescription for the patient. In the literature there are important studies related to the area of medication reconciliation; however, particularly in our field, the severity of the problem is unknown, since there are few local publications on the topic proposed in this study. The objective of this study is to analyze the medication reconciliation process in patients admitted to the Medical Clinic of a teaching hospital of medium complexity by verifying discrepancies found between the drugs prescribed to patients at admission in relation to what was already of chronic use in order to complement the work carried out by clinical pharmacists in the Medical Clinic and ensure safer health care processes. (AU)

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