Medication Reconciliation in Oncologic Palliative Care

Abstract

Introduction: The lack of information about the medications used by the patient can cause medication errors, so communication between health professionals, patients and family members is paramount for patient safety at different levels of attention to health. Clinical pharmacists can perform drug reconciliation and work in collaboration with other professionals to optimize pharmacotherapy and improve the patient’s safety. Patients in Palliative Care tend to use polypharmacy, and when not accompanied by health professionals are susceptible to potential unintentional discrepancies caused by poor communication. Objective: To analyze the characteristics of the profile of drug reconciliations in patients who are under Oncologic Palliative Care. Method: Cross-sectional, analytical, and descriptive study. All the reconciliation visits performed at the admission of the patients were analyzed in the hospitalization unit of the National Cancer Institute José Alencar Gomes da Silva (HCIV/INCA), from June to November 2018. Results: A total of 194 visits were conducted, where 1,770 discrepancies (78.2%) were found, 93.8% intentional, 0.7% intentional documented and 5.4% unintentional. All the prescriptions presented at least one discrepancy and 34.5% were totally modified by the prescriber on admission. There were 112 pharmaceutical interventions related to medication reconciliation. Conclusion: The main discrepancies found, inclusion of drugs and dose adjustments, highlights the importance of the presence of clinical pharmacists at the time of the patient’s admission, when it was possible to adjust pharmacotherapy, together with the clinical staff and contributing to the improvement of the prescription profile.