Article Text

PDF
Medication reconciliation in a Swiss hospital: methods, benefits and pitfalls
  1. Carole Nachar1,
  2. Olivier Lamy2,
  3. Farshid Sadeghipour1,3,4,
  4. Antoine Garnier2,
  5. Pierre Voirol1,3,4
  1. 1 Service of Pharmacy, Lausanne University Hospital (CHUV), Lausanne, Switzerland
  2. 2 Service of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
  3. 3 School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
  4. 4 School of Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
  1. Correspondence to RPh Carole Nachar, Service of Pharmacy, Lausanne University Hospital (CHUV), Lausanne 1011, Switzerland; carole.nachar{at}chuv.ch

Abstract

Objectives To assess the feasibility and main obstacles to the implementation of a medication reconciliation (MR) process in a Swiss hospital and to develop a standardised method which can be used in similar healthcare systems.

Methods For this prospective, observational single-centre and single-ward study, a best possible medication history (BPMH) was established by a clinical pharmacist for 147 patients with heart failure based on two sources and a patient interview for each case. Identified discrepancies with medication histories established during emergency service were conveyed to the ward physician. At the end of each hospital stay, the planned discharge treatments were compared with the BPMHs to identify discrepancies and to propose modifications. After a final validation, the comparative treatment plans were distributed.

Results MR was conducted for 120 (82%) patients and the mean time needed was 74 min/patient. At least one discrepancy was identified among 94% of the patients on admission, with 4.1 discrepancies found per patient (mainly omissions). At discharge, 83% of the patients had at least one discrepancy, with 2.3 discrepancies found per patient (mainly unintentional substitutions). The majority (86%) of pharmaceutical interventions to adjust the discharge prescriptions were accepted by the physician.

Conclusions A standardised method of MR which offers precise definitions of discrepancies and key tools for the process was developed. This method was applicable to most of our cohort and it effectively identified medication discrepancies. Two potential obstacles for its implementation are the time needed for MR and the questionable impact of pharmaceutical interventions on discrepancies.

  • clinical pharmacy
  • medication reconciliation
  • medication discrepancies
  • hospital
  • admission
  • discharge

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.