[Conciliation discrepancies at hospital discharge].

OBJECTIVE To evaluate and describe the non-justified discrepancies found on reconciling chronic medication prescribed to patients when discharged from hospital. Secondly, the impact of the reconciliation process is evaluated by assessing the seriousness of the discrepancies. DESIGN Cality study. SETTING Short Stay Medical Unit in Elda General Hospital, Alicante, Spain. PARTICIPANTS All patients discharged were included. INTERVENTION The medication that the patient was taking before admission was obtained by personal interview before being discharged. The discrepancies that were non-justifiable with the treatment on discharge and with the pharmacotherapeutic history were identified and modified, where necessary, after consulting with the doctor. MEDITIONS AND RESULTS: Of the 434 patients interviewed, 249 conciliation errors were detected, which was 0.57 discrepancies per treated patient. Among the 35.2% of patients who had conciliation errors, the mean number of discrepancies was 1.62. Of these errors, 153 (61.5%) were produced when being discharged, while 96 (38.5%) were errors of omission or commission in the pharmacotherapeutic history. Of all the discharge reports reviewed, 11% did not record information on the previous treatment of the patient. Omission was the main type of error, both in the history and on discharge. As regards the potential harm of the detected errors, 30% could have caused temporary harm or hospitalisation. CONCLUSION Medication errors in the pharmacotherapeutic history at the time of being admitted are common and potentially significant if they are continued. Including the pharmacist in the medical team, along with being able to access data at the different care levels, could help to reduce the frequency of these errors.