PS-083 Medication review and medication reconciliation: most frequent errors in elderly polymedicated patients

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Medication errors are currently a health problem of great magnitude, which causes the appearance of problems related to drugs and adverse drug reactions, an increase in morbidity and mortality, and healthcare costs.


To analyse the impact of pharmaceutical interventions in traumatology and emergency services in a tertiary hospital.

Material and methods

A retrospective descriptive study was conducted from June to July 2016. We choose emergency and traumatology departments because in our hospital there are a multidisciplinary team in these units, including an internist, geriatrician, orthopaedic surgeon and pharmacist. In the emergency department we only selected institutionalised patients, while in the traumatology service we selected patients with some type of fracture, whether or not they were institutionalised. We identified newly hospitalised patients aged >75 years and compared patients’ usual medicines with prescribed medicines. Data collected were: number of patients reconciled, number of drugs evaluated, number and type of discrepancies, and medicine errors identified.


We reconciled 68 patients (mean age 86.5 years) (53 women). Each patient took an average of 9.7 drugs chronically. A total of 81 recommendations were made. This corresponds to an average of 1.2 recommendations per patient (0–8). Of the total recommendations, 70 corresponded to unjustified discrepancies and 19 accounted for prescription errors. The main types of discrepancies were unjustified omission (24), commission (10), duplication (2), dosage (26) and unnecessary medication (8). The main prescription errors detected were dosage (1), duplication (1), indication (1), STOPP-START criteria1 (2) and pharmacotherapeutic exchanges (14). Of the 68 patients reconciled at admission, 37 required more than 1 pharmaceutical intervention. Among the types of interventions, 33 required more than 1 pharmaceutical intervention corresponding to unjustified discrepancy, and there were 14 prescription errors.


Medicines reconciliation is important in emergency and traumatology departments because of the proportion of elderly patients and the amount of drugs for chronic treatment, and numerous discrepancies requiring clarification. Omission of a medicine was the most common unjustified discrepancy. The pharmaceutical intervention is important in order to avoid possible medications errors that could cause damage to the patient. We should improve communication with clinical teams to encourage patient safety.

References and/or acknowledgements

1. Delgado Silveira E, et al. STOPP/START criteria. Rev Esp Geriatr Geronto2014.

References and/or acknowledgements

No conflict of interest

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