Importance of the medication reconciliation service in the community pharmacy

76-year-old patient with cognitive difficulties, polymedicated that lives alone, the pharmacy has been making to him the SPD for 3 months. Among the pathologies, heart failure and uncontrolled atrial fibrillation stand out, so it is medicated with apixaban 5 mg as secondary prevention. He goes to the pharmacy with a hospital discharge report, in which, the doctor gives the order to withdraw the anticoagulant, because he was with triple therapy. When the report was compared with the usual medication, we realized that was happened an unintended discrepancy and that required immediate clarification because of the medications it contained. After contacting with the doctor in charge, it was deduced that the reconciliation error had been caused by an inadequate and outdated record of the patient’s information, so she re-established the usual medication and updated the patient’s pharmacological history. Using the CLEO tool, this intervention had a greater clinical impact by avoiding a hospital stay, a negative economic impact, by increasing the cost of treatment and a positive organizational impact, because it meant an increase in the quality of the service.  

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