Avaliação da conciliação medicamentosa na admissão de pacientes em um hospital privado

Abstract

Introduction: Medication reconciliation is an important patient safety strategy that involves comparing a patient's preadmission medication list with medication orders during transitions of care, identifying discrepancies, and communicating changes to reduce medication errors. Objective: This study aimed to demonstrate the effectiveness of medication reconciliation in identifying and resolving medication discrepancies at the admission of adult patients to a private hospital. Methods: The study was approved by the Research Ethics Committee of Hospital Universitário Edgard Santos under opinion number 7,367,654, in accordance with Resolution No. 466/2012. This prospective observational study was conducted between February and March 2025 at a private hospital in Salvador, Bahia, Brazil. Patients aged ≥18 years, receiving at least one chronic medication before admission, and admitted to selected hospital units were included through convenience sampling. The Best Possible Medication History (BPMH) was obtained by the hospital's clinical pharmacy team using a standardized form, comparing preadmission medications with initial hospital prescriptions. Discrepancies were classified as intentional, undocumented intentional, or unintentional. The Anatomical Therapeutic Chemical (ATC) classification system was used to categorize the medications involved, pharmaceutical interventions were documented, and their acceptance by the medical team was assessed. Data were analyzed using descriptive statistics. Results and Conclusion: A total of 133 patients were included (mean age 60.6 ± 19.3 years; 72.9% female). Among 806 preadmission medications, 332 discrepancies (41.2%) were identified: 133 (40.1%) intentional, 148 (44.6%) undocumented intentional, and 51 (15.4%) unintentional, corresponding to a mean of 0.38 ± 0.80 unintentional discrepancies per patient. Most unintentional discrepancies were medication omissions (90.1%), and the most frequently involved ATC classes were cardiovascular system drugs (29.4%) and alimentary tract and metabolism drugs (17.7%). Patients taking more than six medications experienced a higher rate of unintentional discrepancies (1.69 ± 1.25 per patient). Of the 43 pharmaceutical interventions performed, 86% were accepted by the medical team. Medication reconciliation proved effective in detecting and correcting medication discrepancies at hospital admission, with a high acceptance rate of pharmaceutical interventions. These findings highlight the need to standardize documentation of therapeutic decisions and prioritize patients receiving polypharmacy in order to further enhance patient safety.