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Objective: To classify the frequencies and types of pharmaceutical interventions related to medication reconciliation performed in the hospital emergency room. Methods: This is a retrospective sectional study of medication reconciliation carried out in the emergency department of a referral hospital in cardiology from June 11 to August 11, 2019. All patients admitted to the sector at the corresponding period and that have been reconciled were selected for the study. Patients’ home medications were classified according to the Anatomical Therapeutic Chemical Classification and as reconciled, not reconciled or reconciled after pharmaceutical intervention. Types of pharmaceutical interventions considered: suggestions for correcting the omission of patients’ home medications, dose or frequency. Interventions were classified as accepted or not accepted. The patients were divided into two groups: no discrepancies or intentional discrepancies (G1) and unintentional discrepancies (G2). The groups were compared using the Student’s T test (continuous data) and chi-square (x2) or Fisher’s exact test (categorical variables), considering statistical significance values of p <0.05. Results: 182 admissions were analyzed, with an average number of patient’s home medications use of 4.9 ± 3.6 drugs per patient. Of the 900 patients’ home medications, discrepancies were found in 227 medications on medical prescription of admission at the emergency room, being 48.9% intentional discrepancies and 51.1% unintentional discrepancies. Regarding unintentional discrepancies, 81% were due to the medication’s omission correction on the medical prescription; 9.5% were correction of divergent dose of patients’ home medications and frequency of administration respectively and all were adjusted after pharmaceutical intervention. 139 pharmaceutical interventions were performed to correct medication discrepancies, with 83.5% of acceptance by medical staff. Among all the analyzed medications, 51.8% had at least one registration failure by medical and/or nursing staff. Conclusion: The presence of the pharmacist in the emergency room reduced the incidence of unintentional discrepancies related to medication reconciliation, through interventions to correct medication omissions, dose and frequency, being an important element for patient safety.

Medication reconciliation in emergency department - the role of clinical pharmacist