title: [Medication reconciliation on hospital admission in patients with multiple chronic diseases using a standardised methodology].
abstract: OBJECTIVE
  To determine the incidence of medication errors when admitting patients with multiple chronic conditions to hospital, using a standard method.
  
  
  METHODS
  A prospective, observational study was conducted on patients with multiple chronic conditions admitted to a tertiary hospital. The medication reconciliation was performed using the standard method considered the most suitable for these patients by an expert panel, following the Delphi methodology. The main information source used for this was the computerised clinical notes, both in primary care and in the hospital, recurring to a clinical interview if necessary. Discrepancies justified by the clinician, as well as reconciliation errors were recorded. The type of error and the pharmacological group involved were analysed and the seriousness of each one of them was assessed.
  
  
  RESULTS
  A total of 114 patients were included, with reconciliation errors being found in 75.4% of cases. The patients had 1397 prescribed drugs, of which 234 had discrepancies that required clarification by the clinician responsible. The clinician modified the prescription in 184 of these discrepancies, which were considered reconciliation errors. The types of error were: medication omission (139), commission (9), dose, prescription or different routes (24) and by incomplete prescription (12). Anti-anaemic drugs, vitamins, and psychoanaleptics were among the pharmacotherapeutic groups most affected by the errors.
  
  
  CONCLUSIONS
  The percentage of patients with multiple chronic conditions with errors is elevated. The development of methods particularly directed at patients with multiple chronic conditions manages to detect and decrease a high percentage of medication errors associated with changes of care levels.
authors.affiliation: Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España. eralfarolara@gmail.com
authors.forename: Eva Rocío
authors.initials: ER
authors.lastname: Alfaro-Lara
authors.forename: Bernardo
authors.initials: B
authors.lastname: Santos-Ramos
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: González-Méndez
authors.forename: Mercedes
authors.initials: M
authors.lastname: Galván-Banqueri
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Vega-Coca
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Nieto-Martín
authors.forename: Manuel
authors.initials: M
authors.lastname: Ollero-Baturone
authors.forename: Concepción
authors.initials: C
authors.lastname: Pérez-Guerrero
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D059065:Medication Reconciliation / Q000379:methods* / Q000592:standards*; D010343:Patient Admission; D011446:Prospective Studies