Medication Reconciliation Upon Hospital Discharge Within Community Pharmacy: A Case Study

An 86-year-old female (itinerant between two autonomous regions) with persistent atrial fibrillation (AF) with controlled ventricular fibrillation (VF) with oral anticoagulation, dysthymia, anxiety disorder, essential tremor and chronic venous insufficiency arrives to the community pharmacy after visiting her primary care physician (PCP). She has been diagnosed at hospital discharge (in another region) with ischemic parietal cardioembolic ictus. No reconciliation was made to the discharge and when dispensing the prescriptions of the MAP we detected that there are some duplicities, there are prescriptions that are not in the discharge report and there are no prescriptions for many others according to what appears in the discharge report.