Reconciliação Medicamentosa Liderada por Farmacêuticos em Maternidade Pública da Bahia: Contribuição para a Segurança do Paciente nas Transições de Cuidado

Abstract

Introduction: Medication reconciliation is recognized by organizations such as the World Health Organization (WHO) and the Institute for Healthcare Improvement (IHI) as an essential practice for patient safety during transitions of care. Pharmacists play a central role in this process by identifying, correcting, and preventing unintended discrepancies between previous and current prescriptions. Evidence indicates that pharmacistled interventions reduce clinically relevant discrepancies, decrease medication errors, and, in some settings, reduce hospital readmissions and emergency department visits. Despite this, the systematic implementation of medication reconciliation still faces challenges that compromise its coverage and effectiveness. Objective: To evaluate the profile of medication reconciliations performed by pharmacists during hospital admission and discharge of pregnant and postpartum women, as well as the frequency, characteristics, and outcomes of interventions related to drugrelated problems (DRPs). Methods: A descriptive crosssectional study conducted between March and July 2025. Data on DRPs were entered into the REDCap® platform by the pharmacists responsible for medication reconciliation. DRPs were classified using an adapted and validated version of the Pharmaceutical Care Network Europe (PCNE) Classification for DrugRelated Problems v9.1. Data on hospital admissions and discharges were obtained from reports generated by the maternity hospital’s AGHUx system. The study is part of a research project approved by the Research Ethics Committee (CAAE 80569324.7.0000.5543). Results and Conclusion: During the study period, 1,006 admission reconciliations were performed (76.4% of 1,317 eligible admissions) and 537 discharge reconciliations (38.9% of 1,379 discharges). A total of 136 DRPs involving 167 medications were identified (8.8% of all reconciliations). The medications most frequently involved were ferrous sulfate (46.1%), nonformulary medications (19.2%), calcium carbonate + vitamin D (6.0%), chlorpromazine (4.2%), enoxaparin (3.0%), and levomepromazine (1.8%). Among the nonformulary medications, 28.1% were controlled substances under Ordinance No. 344/1998, 28.1% were multivitamins/supplements, 15.6% were different formulations of formulary medications, and 12.5% were folic acid. Of the 78 interventions performed (covering 54.4% of DRPs), 67 (85.9%) were accepted by prescribers. Analysis showed that 85.3% of DRPs did not reach the patient. Pharmacist involvement in medication reconciliation proved essential for the early detection and resolution of discrepancies that could compromise patient safety. The high acceptance rate of pharmacist interventions and the prevention of DRPs before reaching the patient reinforce the effectiveness of the process. The low coverage of medication reconciliation at hospital discharge represents an important opportunity for improvement, as discharge is a critical stage for ensuring continuity of pharmacotherapy.