5PSQ-037 Importance and impact of pharmaceutical reconciliation at discharge in the elderly patient with polymedication

• Published in: European journal of hospital pharmacy. Science and practice Vol. 30; no. Suppl 1; p. A124
• Main Authors: Vara Urruchua, M, Vila Gallego, C, Inclan Conde, M, Belio Aguera, B, Gomez Echevarria, N, Perez España, Z, Pardo Santos, NM, Aguirrezabala Arredondo, AV
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 23.03.2023; BMJ Publishing Group LTD
• Subjects: Conflicts of interest; Contraindications; Patient safety; Pharmacists; Reconciliation; Section 5: Patient safety and quality assurance
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2023-eahp.258

Background and ImportanceMedication reconciliation is a key tool to increase patient safety and can be very useful in the polymedicated elderly.Aim and ObjectivesThe aim of the study is to assess the impact of reconciliation and to identify and prevent reconciliation errors (CE) in polymedicated elderly.Material and MethodsA prospective study was conducted consisting in a medication reconciliation project at discharge, with a pharmacist in charge, in patients admitted to the care of MDI during the period October to December 2021. Patients over 65 years of age and polymedicated (> 5 prescribed drugs) were included.The pharmacist in charge was responsible for comparing the medication prescribed in the updated e-prescription with the hospital e-prescription and the discharge medical report. He recorded, evaluated and classified the ‘reconciliation errors’, those that were modified by the prescriber after the pharmacist's warning according to the SEFH Consensus Document on terminology and classification in medication reconciliation.We classified the CEs into seven: dosage discrepancy, omission in the prescription, commission, prescription of a drug not indicated or contraindicated due to the patient's clinical situation, incomplete prescription and duplicity.ResultsDischarge reconciliation was performed in 113 patients, 51% of whom were women. The mean age was 82.4 years (62-100). The mean number of drugs prescribed per patient was 11 (5-22). Sixty-nine (61%) unjustified discrepancies were detected of which 57 (50%) were reported to the responsible physician and 50 were accepted, 88% of the reported discrepancies and 72% of the total, i.e. CE occurred in 72% of the reconciled patients.Regarding the classification of discrepancies detected, the majority were posological discrepancies constituting 39.1% (27); followed by 27.5% (19) maintaining a drug not indicated or contraindicated for the current clinical situation; omission of drugs in 18.8% (13); commission 8.7% (6), incomplete prescription 4.3% (3) and duplicity 1.4% (1).Conclusion and RelevancePharmacotherapeutic reconciliation resulted in a significant reduction in the incidence of CD and its impact, constituting a strategy to improve safety in polymedicated elderly patients. The presence of a pharmacist on the hospital ward is very useful to carry out this task, improving communication between professionals and contributing to a more effective reconciliation.References and/or AcknowledgementsConflict of InterestNo conflict of interest.