title: [Conciliation discrepancies at hospital discharge].
abstract: OBJECTIVE
  To evaluate and describe the non-justified discrepancies found on reconciling chronic medication prescribed to patients when discharged from hospital. Secondly, the impact of the reconciliation process is evaluated by assessing the seriousness of the discrepancies.
  
  
  METHODS
  Cality study.
  
  
  METHODS
  Short Stay Medical Unit in Elda General Hospital, Alicante, Spain.
  
  
  METHODS
  All patients discharged were included.
  
  
  METHODS
  The medication that the patient was taking before admission was obtained by personal interview before being discharged. The discrepancies that were non-justifiable with the treatment on discharge and with the pharmacotherapeutic history were identified and modified, where necessary, after consulting with the doctor. MEDITIONS AND RESULTS: Of the 434 patients interviewed, 249 conciliation errors were detected, which was 0.57 discrepancies per treated patient. Among the 35.2% of patients who had conciliation errors, the mean number of discrepancies was 1.62. Of these errors, 153 (61.5%) were produced when being discharged, while 96 (38.5%) were errors of omission or commission in the pharmacotherapeutic history. Of all the discharge reports reviewed, 11% did not record information on the previous treatment of the patient. Omission was the main type of error, both in the history and on discharge. As regards the potential harm of the detected errors, 30% could have caused temporary harm or hospitalisation.
  
  
  CONCLUSIONS
  Medication errors in the pharmacotherapeutic history at the time of being admitted are common and potentially significant if they are continued. Including the pharmacist in the medical team, along with being able to access data at the different care levels, could help to reduce the frequency of these errors.
authors.affiliation: Servicio de Farmacia, Hospital General de Elda, Elda. Alicante. España. hernandez_carpra@gva.es
authors.forename: Carmen
authors.initials: C
authors.lastname: Hernández Prats
authors.forename: Amalia
authors.initials: A
authors.lastname: Mira Carrió
authors.forename: Elena
authors.initials: E
authors.lastname: Arroyo Domingo
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz Castellano
authors.forename: Lucio
authors.initials: L
authors.lastname: Andreu Giménez
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Sánchez Casado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D055815:Young Adult