Medication reconciliation: a prospective study in an internal medicine unit.

Background: Medication reconciliation has proved its effectiveness at improving drug-prescription safety. This study was undertaken to assess the impact of an intervention aimed at decreasing the discrepancies between a patient's usual treatment(s) and medications prescribed at admission.

Methods: Our study was conducted from November 2010 to May 2011. Discrepancies between home medication( s) and drugs prescribed to every patient aged C65 years, transferred from the Emergency Department and hospitalized in the Internal Medicine Unit, were analyzed.

Results: During this 6-month period, 170 patients were prospectively included, with a total of 1,515 medicines reconciled. The unintentional discrepancy rate declined from 4.3 to 0.9 % after the intervention. The main sources of discrepancies concerned alimentary tract and metabolism (25.7 %), cardiovascular (24 %), and nervous system drugs (19.4 %).

Conclusions: The results of this study demonstrated that acquisition of patients' medication history is often incomplete or incorrect. Pharmacists seem to be especially well suited to help medical teams rectify this situation. However, the cost effectiveness of this intervention needs further assessment.