Profile of pharmaceutical interventions related to medication reconciliation performed in a public tertiary hospital and associated factors
DOI:
https://doi.org/10.47456/rbps.v26i1.40429Keywords:
Medication Reconciliation, Pharmacy service in Hospital, Patient safety, Transitional careAbstract
Introduction: Medication reconciliation (CM) is the process of obtention of the best possible medication history to ensure the transfer of information and correction of discrepancies during the transitions of care, promoting patient safety. Objectives: To analyze the profile of discrepancies and pharmaceutical interventions carried out in a CM service and factors associated with medication discrepancies at the time of hospital admission. Methods: Descriptive study of a CM service carried out when admitting patients to a public reference hospital for Covid-19 during the pandemic. The frequency of absence of CM at admission was described; factors associated with this variable were evaluated with uni and multivariate analyses. Results: 1,276 patients were evaluated in the service. The majority were female (55.4%), aged ≥ 60 years (64.6%) and with polypharmacy (59.2%). Age ≥ 60 years and polypharmacy were negatively associated with the absence of prescription discrepancies. 925 pharmaceutical interventions were carried out in response to discrepancies, with a minority being accepted (27%). The main justifications for refusing interventions were: replacement with formulary medication (51.9%) and the patient’s clinical condition (34.2%). The medications for thyroid therapy were the class with the highest percentage of accepted interventions (52.6%). Conclusion: Performing CM during the pandemic in a reference hospital proved challenging, with low acceptability of interventions, but significant changes in pharmacotherapy for some important health conditions. Such results, including associated factors identified, can be used to improve the service.
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