title: The impact of medication reconciliation program at admission in an internal medicine department.
abstract: BACKGROUND
  Medication reconciliation process has proved to be an effective tool to improve the safety of drug use. The objective of this study was to assess the impact of an intervention aimed to decrease unintended discrepancies between patient's usual treatment and medications prescribed on admission to the Department of Internal Medicine.
  
  
  METHODS
  A quasi-experimental study was carried out from June 2009 to May 2010, analyzing discrepancies between home medication and drugs prescribed in a tertiary care hospital, before (first phase) and after (second phase) an electronic reconciliation tool was introduced at admission. This tool connected patients' usual medication with the electronic prescription program. The research team was made up of two hospital pharmacists, two nurses and three physicians from the Internal and Preventive Medicine Departments.
  
  
  RESULTS
  During the two phases of the study, 162 patients were included with a total of 1,959 medicines reconciled. The incidence of unintended discrepancies decreased from 3.5% to 1.8% after the intervention (p value 0.03). The proportion of patients with at least one unintended discrepancy was 23.7% in the first phase and 14.6% in the second phase (p value 0.20). Omission was the most common unintended discrepancy. Asthmatic patients showed 6 times higher risk of being affected by an unintended discrepancy (OR 6.37, 95%CI 1.6-25.5; p value 0.009).
  
  
  CONCLUSIONS
  Implementing a computerized tool integrated into the electronic prescribing program could be very helpful to develop a medication reconciliation process. It is essential to involve all hospital staff in this process.
authors.affiliation: Preventive Medicine and Quality Management Department, Hospital General Universitario Gregorio Marañón, C / Doctor Esquerdo, 46-28007 Madrid, Spain. anaclarazoni@gmail.com
authors.forename: Ana Clara
authors.initials: AC
authors.lastname: Zoni
authors.forename: María Esther
authors.initials: ME
authors.lastname: Durán García
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Jiménez Muñoz
authors.forename: Roberto
authors.initials: R
authors.lastname: Salomón Pérez
authors.forename: Paloma
authors.initials: P
authors.lastname: Martin
authors.forename: Ana
authors.initials: A
authors.lastname: Herranz Alonso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy; D005260:Female; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration; D059065:Medication Reconciliation / Q000379:methods* / Q000458:organization & administration*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration; D015397:Program Evaluation; D062606:Tertiary Care Centers / Q000458:organization & administration*