Abstract

Although the literature shows several studies on medication safety, there are few Latin American studies describing aspects in the practice of medication reconciliation carried out by pharmacists in the admission process. This study aimed to describe the acquisition of medication use history of patients during admission, and to characterize the unintentional discrepancies in their pharmacotherapy in a Brazilian teaching hospital. This cross-sectional study was conducted within the University Hospital of the Federal University of Sergipe. Pharmacist-researchers collected patient data in four steps through a structured questionnaire developed by the researchers and adapted from the literature. After collection, the pharmacist-researcher and pharmacy students analysed the data and assessed if there were any unintentional discrepancies. The present study defined unintentional discrepancies (UD) as the unjustified variations between the patient’s previous medication use history and the pharmacotherapy prescribed during hospitalization. In this study, 358 patients were included. Of all patients, 261 (72.90%) were adults with the mean age of 47.16 ± 18.80 years. In 117 cases of adult patients (44.82%), there was no record of previous pharmacotherapy, and 137 (52.49%) were not questioned about their allergies. A total of 327 UD were found in 150 patients (41.90%). Of these UD, omission was the most common type, followed by different doses, erroneous frequency, and unjustified start of treatment. This study revealed the prevalence of unintentional discrepancies in the studied hospital, and points out that the assessment of the history of medications used is a complex practice, in which the pharmacist can be an ally.

Key words: Patient safety, medication errors, medication discrepancies, medication reconciliation.