Development and Application of a Computerized System for Medication Reconciliation in a Hospital Environment

Abstract Introduction: The World Health Organization (WHO) is concerned with ensuring patient safety in all health services. Thousands of people suffer from errors and adverse events related to medications 2 . Hospitals lack financial conditions, human resources, infrastructure, and computerized support systems for the implementation of clinical pharmacy, pharmacovigilance and medication reconciliation services. The introduction of systems that help the rational use of medicines (RMU), which is one of the pillars of safety in health services, is very relevant, especially for patients and pharmacists. Objective: To develop and apply a computerized pharmaceutical decision support system for the medication reconciliation in a general hospital. Method: Study of the development and application of a digital tool, with a cross-sectional design, for the comparison between manual medication reconciliation performed by the pharmacist and medication reconciliation performed with a computerized support system. Results: In the medication reconciliation process, the computerized system reduced the time for analyzing prescriptions by eight minutes per patient. Of the 392 patients who were part of the sample, 97.7% used continuous medication at home. Among the list of home medications that were not prescribed in hospital prescriptions and identified through the system are: losartan (9.1%), levothyroxine (4.4%), metformin (3.6%), and medication for mental disorders. depression and anxiety such as: sertraline (2.9%), clonazepam (2.4%) fluoxetine (1.6%). Conclusion: The developed computerized system proved to be superior to the pharmacist's manual search during medication reconciliation and clinical pharmacy and can be a valuable tool in pharmaceutical care.