title: [Medication reconciliation: an innovative experience in an internal medicine unit to decrease errors due to inacurrate medication histories].
abstract: OBJECTIVE
  An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization. Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital. The aims of this prospective study were to evaluate the interest in clinical practice of this concept and the resources needed for its implementation.
  
  
  METHODS
  We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010. We obtained an accurate list of each patient's home medications. This list was then compared with medication orders. All medication variances were classified as intended or unintended. An internist and a pharmacist classified the clinical importance of each unintended variance.
  
  
  RESULTS
  Sixty-one patients (mean age: 78 ± 7.4 years) were included in our study. We identified 38 unintended discrepancies. The average number of unintended discrepancies was 0.62 per patient. Twenty-five patients (41%) had one or more unintended discrepancies at admission. The contact with the community pharmacist permitted us to identify 21 (55%) unintended discrepancies. The most common errors were the omission of a regularly used medication (76%) and an incorrect dosage (16%). Our intervention resulted in order changes by the physician for 30 (79%) unintended discrepancies. Fifty percent of the unintended variances were judged by the internist and 76% by the pharmacist to be clinically significant.
  
  
  CONCLUSIONS
  The admission to the hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories.
authors: Hôpital d'instruction des armées-Clermont-Tonnerre, service de pharmacie, CC41, 29240 Brest cedex 9, France. maud.perennes@yahoo.fr
authors: Maud
authors: M
authors: Pérennes
authors: Axel
authors: A
authors: Carde
authors: Xavier
authors: X
authors: Nicolas
authors: Manuel
authors: M
authors: Dolz
authors: René
authors: R
authors: Bihannic
authors: Pauline
authors: P
authors: Grimont
authors: Thierry
authors: T
authors: Chapot
authors: Hervé
authors: H
authors: Granier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008499:Medical Records / Q000592:standards; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D059065:Medication Reconciliation / Q000379:methods* / Q000706:statistics & numerical data; D019338:Polypharmacy; D055553:Prescription Drugs / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D055553:Prescription Drugs