Background For 7 years, the visceral surgery department (VSD) has benefited from Best Possible Medication Histories (BPMH) at hospital admission. For now BPMH are performed by a pharmacy student, validated by a pharmacist and recorded in the patient medical electronic file, to facilitate his consultation by surgeons.
Purpose The main purpose of this study was to evaluate the medication reconciliation process in the VSD.
Material and methods We present a prospective study performed from February to March 2017 and including all hospitalised patients in VSD having a BPMH with at least one medication. The collected data were:
Patient: age, medication number, length of stay, time delay for BPMH availability.
The number and nature of information sources regarding patient medication.
Pharmaceutical benefit depending on the number of medication only found during the medication reconciliation process.
Number of BPMH consultations.
Semi-structured interviews were performed among prescribers and feedback was analysed.
Results Forty-seven patients were included (age: 67.9±14.2 years). The length of stay was 7.1±5.2 days. BPMH reported 285 medications (6.1±3.8 treatments per patient). Fifty-nine per cent of BPMH were available within 24 hours after patient admission.
The number of information sources was 2.9±0.7 by BPHM. Twenty-eight patients were interviewed, 33 prescriptions were collected: 34 pharmacies, five general practitioners and three nursing homes were contacted.
The mean BPHM consultation number was 2.1±2.0 times and these were mostly done by pharmacists. Only seven BPMH (14.9%) were consulted by resident surgeons.
A pharmaceutical benefit was described for 55% of patient: 95 treatment lines and 17 missing posology were added by the pharmacy
BPMHs were considered as complete and precise by all resident surgeons. However, they were not used in priority to prescribe. The main negative finding was the low surgeon interest in the BPMH in patients with little comorbidity.
Conclusion The current process allows the fast realisation of reliable BPMH. Nevertheless, communication between the pharmacist and the medical team is necessary in improving the pertinence of the process, in particular in patient selection.
No conflict of interest
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