Atuação do farmacêutico clínico na implantação da conciliação medicamentosa: estudo de caso em um hospital municipal de pequeno porte.

Abstract

This study aimed to determine the importance of the pharmacist's role in the implementation of medication reconciliation. A case study was conducted in a small municipal hospital through interviews with patients and caregivers during the hospital admission process. The data collected were used to complete medication reconciliation forms, which enabled the analysis of information such as age, sex, comorbidities, medications used prior to admission, hospital prescriptions, and possible discrepancies. The results showed that 71% of patients presented some type of medication discrepancy, with 41% being unintentional, 24% involving both intentional and unintentional discrepancies, and 6% only intentional. Only 21% of the medications were properly prescribed at hospital admission, and 59% of the patients used their own medications during hospitalization. Many discrepancies were found to result from the lack of inquiry by the medical team and the patients' lack of awareness about the importance of spontaneously reporting their medication use. Despite the study's limitations, such as time constraints and operational difficulties, the relevance of the pharmacist's role in medication reconciliation was evident. This tool proved essential for patient safety, contributing to the prevention of failures in the medication-use process and reinforcing the pharmacist’s clinical role within the multidisciplinary team.