Background Medication reconciliation (MR) at admission is a multidisciplinary process which aims to ensure hospital prescriptions. MR consists in obtaining the complete and accurate list of medications taken by the patient at home, the best possible medication history (BPMH), then using BPMH to ensure the medication order. Two approaches are possible: retroactive when BPMH is produced and considered after the prescription is written; and proactive when BPMH is produced before and is considered in the initial prescription. Proactive MR is promoted as a safer approach, but the lack of human resources is often presented as a major limiting factor to set it in practice.
Purpose Thus, the aim of our study was to determine which approach was the most time-effective.
Material and methods We conducted a single-centre prospective study between June and October 2018. Patients over 65 years’ old, hospitalised in a neurology unit in a university hospital were included, and randomly assigned to either the proactive or retroactive group (ratio1:1).
The delay between patient’s entry and the completion of MR.
Time spent to perform each step of the process (working time).
The delay between patient’s entry and first prescription.
In all cases, we compared BPMH to the first hospital prescription, and recorded unintentional medication discrepancies (UMD).
Results Sixty patients were enrolled in the study. The two groups were comparable in terms of demographics and number of medications in BPMH. In the proactive group, we measured:
A significant decrease in the delay between patient’s entry and the completion of MR (3.0±1.8 h vs 13.7±14h, P<0.0001).
No difference in working time (26.6±9.3 min vs 30.1±10.3 min, P=0.17).
No difference in the delay between patient’s entry and first prescription (2.4±1.1 h vs 2.4±2.0h, P=0.96).
A significant decrease in the number of patients with at least one UMD (13.3% vs 73.5%, P<0.0001) and the average number of UMD per patient (0.3±0.7 vs 1.8±1.7, P<0.001).
Conclusion We demonstrated that proactive MR improved the delay of MR, without increasing the working time nor delaying the time of first prescription. We confirmed that proactive is safer than retroactive in a neurology unit.
References and/or acknowledgements None.
No conflict of interest.
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