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5PSQ-217 Medication reconciliation programme of the complex chronic patient in a traumatology and orthopaedic surgery service at hospital admission
  1. L Martinez-Dueñas,
  2. B Muñoz Cejudo,
  3. MR Cantudo Cuenca
  1. Hospital San Agustin, Pharmacy, Linares- Jaen, Spain


Background and importance Medication errors constitute an important health problem due to their clinical and economic impact. Management of the chronic polymedicated patient during hospitalisation is a highly relevant task in clinical practice.

Aim and objectives To quantify and analyse discrepancies and reconciliation errors (RE) in a traumatology and orthopaedic surgery service (TOS) through a medication reconciliation programme at hospital admission.

Material and methods A prospective study was conducted from January to September 2020. All hospitalised patients were reconciled during the first 24 hours after admission. Demographic and clinical data were collected: diagnosis, history of interest, allergies, analytical data and treatment. The number of no discrepancies, justified discrepancies (JD), not justified discrepancies (NJD) and type of NJD were counted. Discrepancies were classified according to the criteria established in the consensus document on terminology and classification in medication reconciliation of the SEFH. Accepted NJD were recorded, thus accounting for the RE. Drugs involved in the discrepancies and their classification by ATC group were also recorded. Information sources were the electronic prescription programme, electronic medical records and interviews with the patients. Data were analysed with Excel. For quantitative variables, mean (SD) were calculated, and the qualitative variables were expressed as frequencies.

Results 411 patients were reconciled (age 70.43±13.1 years; 62.5% women). 3479 medications were reconciled (8.4 medications/patient) and 2106 (60.5%) had no discrepancies. 1373 (39.5%) discrepancies were detected (JD 1146 (83%); DNJ 227 (17%). The most frequent NJD types were: omission (76%), different dose, route or frequency (19%), wrong medication (2.6%) and commission (1.3%). Of the NJD, 92% were accepted by the prescriber, considering EC, and therefore CDs represented 5.9% of the total number of reconciled medications. The most frequent ATC groups implicated were: cardiovascular system (37.4%), CNS (31.2%), digestive system and metabolism (6.6%), and blood and haematopoietic organs (5.72%). The drugs that most frequently presented RE were hydrochlorothiazide, metformin, bisoprolol, lormetazepam and enalapril.

Conclusion and relevance Medication reconciliation within the first 24 hours of admission is a useful tool to detect errors in prescription. Identification of the most frequent ATC groups in RE allows us to identify those drugs for which it is advisable to review the prescription when validating treatment in the TOS.

Conflict of interest No conflict of interest

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