Medication reconciliation: implantation process in a hospital complex with the use of electronic system

Abstract

This study evaluated the implementation of medication reconciliation in a teaching and multi blocks hospital with the use of an electronic system to record the multidisciplinary activity. A total of 438 nursing professionals were trained on medication reconciliation. From October 2017 to March 2018, the information about previous use of drugs for 1.379 patients was registered by the nurse in the electronic system. Only 25% of these records were reconciled by the pharmacist, and 31% of the total reconciled needed the intervention with the prescriber. The number of patients who had the medication prescribed without any change was 180, 47 had the medication prescribed with some change and 106 had not prescribed the medications of previous use during hospitalization. The use of computerized systems can be useful for teams to perform medication reconciliation, but it depends on the correct use of the system and training of the teams. The daily follow-up of the clinical pharmacist increases the patient safety regarding the use of drugs within the hospitals, but to perform the activity some improvement measures are necessary to obtain compliance with the patients' medication reconciliation in their entirety.