Background Medication reconciliation (MR) has been promoted in the High 5 s project as a way of ensuring patient safety. However, it requires time and hospital staff and cannot be set up in every medical unit (MU).
Purpose To evaluate the relevance of MR at admission in two MU, oncology and cardiology, after 5 (oncology) and 10 (cardiology) months.
Material and methods Reconciliated patients (RP) were of age >75 or 65 with polymedication in cardiology and all patients with a length of stay >2 days in oncology, except when not being interviewed. Discrepancies found between the hospital prescription and best possible medication history obtained through MR were characterised. Causes of hospitalisation were collected.
Results There was 87 RP in oncology and 77 in cardiology (38.2% and 25.1% of admissions). Five hundred and forty-seven discrepancies (6.3/patient) were found in oncology and 325 (4.2/patient) in cardiology. Respectively 12% and 17% (p<0.05) were unintended discrepancies (UD). Forty per cent of RP had a UD in oncology and 38% (NS) in cardiology. In oncology, 13/64 UD (17.2%) were considered at medium risk and two at high risk (3%); in cardiology it was 16/47 UD (8.6%) (NS) and 0 (NS). In each MU, 80% of the UD were corrected. More patients have been reconciliated in oncology in 5 months than in cardiology in 10 months: in cardiology the hospitalisations are scheduled and mostly to adapt the usual treatment of the patients, whereas hospitalisations in oncology are mostly due to a degradation in the patient’s condition with focus on symptomatic treatment and chemotherapy. In oncology, the clinicians adhered to the programme, asking for the inclusion of patients originally not considered: 62% of the hospitalised patients underwent MR. On the contrary, fewer patients were included in cardiology because they came with their prescriptions and were expecting a treatment modification: clinicians preferred a pharmaceutical activity focusing on therapeutic patient education (TPE).
Conclusion MR showed similar results in oncology and cardiology, but in cardiology clinicians were not convinced and the usual treatment was often changed. MR will be pursued in oncology, but discontinued in cardiology.
References and/or Acknowledgements The High 5s Project
No conflict of interest
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