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But it is important to clarify the difference between these terms: discrepancy and REs. Discrepancy is any difference between the home medication the patient was previously taking and the medication prescribed in hospital.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8,9</span></a> Most discrepancies, it must be stated, are “justified” due to intended adjustments arising from the new clinical condition of the patient, even if changes have not been explicitly recorded in the medical history. If these differences or discrepancies are considered “unjustified” and so is confirmed by the prescribing physician, they are called REs.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8,9</span></a> This is very important when interpreting studies on reconciliation, review of the methodology to be essential, because some studies show discrepancies but do not show REs.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> In addition, in other studies, the incidence of errors is overestimated, as they are considered as REs when they actually are discrepancies.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The emergency departments (EDs) are an essential element of the healthcare system, very complex and with very intense activities, increasing the risk of medication errors. EVADUR<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> is a recent study conducted in the ED of 21 Spanish hospitals, in order to analyze the incidence of healthcare-related adverse events (AEs) in the EDs. In this study it has been confirmed that 12% patients had some type of AE, and the second most frequent cause was medication. Specifically, omission of dosage or drug (known as reconciliation problem) was the most frequent medication causal factor, along with drug adverse reactions. The Spanish Society of Emergency Medicine (SEMES), in collaboration with the Working Group on Emergency Care Pharmacy belonging to the Spanish Society of Hospital Pharmacy, has developed a consensus document on MR at the EDs.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> In this document, the drugs are reported in therapy groups, by analyzing the maximum time that should elapse from admission to the ED until the MR is performed, and whether or not the sudden drug discontinuation can cause rebound effects, as well as other clinical variables to be considered when revising treatment. To coordinate acute treatment prescription in the ED with a review of chronic home medication is not an easy task, as the reason for the emergency is what mainly captures the attention, leaving in the background the medication history, particularly when there is no time and reliable information immediately. However, a quality medication history, understood as a complete and current history of the patient's current medication, is very important because it can explain part of the symptomatology bringing the patient to the ED, and the abrupt withdrawal of some medications can cause new health problems.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> Several studies have been published in order to identify differences between the medication history obtained by the emergency physician and the one obtained by the clinical pharmacist in the ED, discrepancies that might involve up to 95% patients.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the article published in this issue of Clinical Medicine by De Andrés-Lazaro et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> the pharmacist identified a greater number of drugs per patient compared to the emergency department physician (6.89 vs 5.70; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). The reason might be, among others, that the pharmacist is focused on the drug and can devote more time to review the patient's medication history. In addition, the pharmacist consults other databases that the doctor usually does not see, such as primary care medication history or electronic prescriptions of health services that also provide information about treatment adherence. It is noteworthy that, frequently, the electronic history is not updated and the patient or family members are the primary source of information. In this article, De Andrés-Lázaro et al. found a large number of discrepancies (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1421), but most of them (83.6%) were justified. Therefore, it is important to stress that adequate reconciliation at admission to hospital does not necessarily imply to prescribe the full list of regular medication, as some medications should be discontinued temporarily due to the new patient's condition. Most important is to know and reflect on the history that all ambulatory patient medication is taken into account, even if it is not prescribed due to the critical features of the episode. And it is important that this information is electronically recorded and transferred to the next level of care so that the impact of the action is spread beyond the ED.</p><p id="par0020" class="elsevierStylePara elsevierViewall">That's why the EDs are particularly important in the MR process, since it is where the first prescription takes place and where the omission of regular medication or registration of a wrong dosage can have more impact on the patient care chain. De Andrés-Lázaro et al. detected 157 REs involving 43% patients. Major RE was the omission of chronic treatment to be maintained, as in most studies.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1,6,10</span></a> RE detection is the added value of the pharmacist. In recent years, the pharmacist has become a good detector of unjustified reconciliation discrepancies, and this is evidenced by the high acceptance rate of their interventions.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> The ultimate purpose of treatment reconciliation should not end with the drafting of a list of drugs. The hospital pharmacist should validate the overall treatment and assess what discrepancies are important considering the new patient's condition. The pharmacist should also cooperate with the practitioner and therefore be included into the healthcare teams, being this cooperation particularly relevant in the ED. Among the variables associated with the RE occurrence, the elderly and polypharmacy have been proved to be risk factors for the occurrence of these errors.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10,12</span></a> Therefore, it is necessary to review and adjust medication in the population where this mainly occurs: the polypharmacy in elderly. In recent years there have been schools of thought focused on deprescriptions<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> using tools such as the Beers criteria or STOPP-START criteria recently updated.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">18,19</span></a> But the study of De Andrés-Lázaro et al. shows how having available additional sources of information was identified as a factor associated with the RE detection. Access to reliable and updated sources of information is critical to allow appropriate medication reconciliation. We therefore believe that all national (or regional) network of healthcare settings should have access to a unified medication register. The Government is working on it, but there is still some way to go toward the unified electronic medical history throughout the national territory. The impact of REs on health outcomes is a topic that would be interesting to study in the future. There are already some publications, including Urbieta Sanz et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a>, which show how, according to the assessment by a group of emergency physiscians independent from the researchers, 58% patients would have suffered damage or would have required intervention had REs not been detected. Currently, there are several measures preventing from the occurrence of REs depending on the health care department; the EDs should be focused on the development of a full medication history and the “copy-paste” treatment of the previous episode, common in some centers, should be avoided. One of the strategies proposed by SEMES is the programs introducing pharmacists in the ED, and the article by De Andrés-Lázaro et al. supports this proposal. In the hospital setting it is important to write discharge reports where treatment is perfectly detailed, avoiding orders such as “other medication the same.” Such statements are known as blanket orders, and are expressly prohibited by the Joint Commission's Medication Management Standards MM.3.20.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> In primary care, electronic medication history has been a significant breakthrough. Therefore, patients and their relatives should be required to attend the ED provided with a copy of all documents detailing full treatment. Nursing collaboration is essential at all levels of care for their proximity to the patient. There are cases where the nurse participates in MR programs<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> identifying discrepancies and training on medication at discharge.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To this purpose, the government and hospital management support is important in order to create a culture of safety that includes the MR as a key strategy in the safe use of the drug. Many pilot studies prove it, but ideally a multidisciplinary team should protocol the process, include it into clinical practice and provide monitoring indicators. It is important to adapt strategies to the peculiarities of each health care setting to identify areas for improvement. This responsibility should be shared by all professionals, not to mention the patient and family members because patient's safety is everyone's responsibility.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Allende Bandrés MÁ, Ruiz Laiglesia FJ. Conciliación de la medicación: una responsabilidad compartida. 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Vol. 145. Issue 7.
Pages 298-300 (October 2015)
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Vol. 145. Issue 7.
Pages 298-300 (October 2015)
Editorial article
Medication reconciliation: A shared responsibility
Conciliación de la medicación: una responsabilidad compartida
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