目标：老年人群，通常是多药，面临不良药物事件的风险。药物和解（MR），这是一个互动和多专业的过程，有助于确保护理的连续性。这项研究的目的是分析和定义老年患者MR的相关优先排序标准，以避免最大程度的用药错误。
方法：前瞻性地对患者入院和出院过渡点的MR进行了10个月的临床审核。根据我们结构中已经建立的优先程序选择患者，即存在以下三个标准中的至少一个：源自医院部门，严重的肾功能衰竭和危险药物的处方。
结果：入院时调和的患者队列包括136名患者。总共确定了63个无意差异（UD），其中大部分(76.2%)涉及药物遗漏。与优化的药物评估相比，三个标准被确定为入门处方中UD风险的独立预测因子：风湿病史，起源于医院部门和低钠血症。在本研究中发现低钠血症是最相关的标准，显着增加患者处方中的UD风险，特别是入院时治疗遗漏的风险。
结论：本研究将改善医疗机构程序的优先标准，并在老年住院中实施MR，以加强城市与医院的联系。
OBJECTIVE: The geriatric population, often polymedicated, is exposed to the risk of adverse drug events. Medication reconciliation (MR), which is an interactive and pluriprofessional process, helps ensure continuity of care. The objective of this study was to analyze and to define relevant prioritization criteria for MR in older patients in order to avoid a maximum of medication errors.
METHODS: A clinical audit of MR at the transition points of patient admission and discharge was conducted prospectively for 10 months. Patients were selected on the basis of a prioritization procedure already established in our structure, that is the presence of at least one of the three following criteria: originating from an hospital department, severe renal failure and prescription of at-risk drugs.
RESULTS: The cohort of patients reconciled at admission included 136 patients. A total of 63 unintentional discrepancies (UDs) were identified, the majority of which (76.2%) involved drug omissions. Three criteria were identified as independent predictors of UDs risk on the entry prescription compared to the optimized drug assessment: rheumatological history, originating from an hospital department and hyponatremia. Hyponatremia was found in the present study to be the most relevant criterion that significantly increased the risk of having an UD on the patient\'s prescription, particularly a risk of treatment omission at admission.
CONCLUSIONS: This study will allow to improve the prioritization criteria on the healthcare establishment\'s procedure and to implement MR in geriatric day hospitalization in order to strengthen the city-hospital link.
