Pharmacist-led medication reconciliation to reduce discrepancies in transitions of care in Spain

摘要

Background Medication errors are one of the main causes of morbidity amongst hospital inpatients. More than half of medication errors occur at 'interfaces of care', when patients are discharged or transferred to the care of another physician. Medication reconciliation is the process of reviewing patients' complete previous medication regimen, comparing it with current prescriptions, and analysing and resolving any discrepancies that the pharmacist does not believe to be intentional (unjustified discrepancies). Objective To quantify and analyse reconciliation unjustified discrepancies detected by a pharmacist in patients admitted to an internal medicine unit (IMU) over a 3-year period.