Background and importance Continuity of medication management in hospitals is a major issue today, and the clinical pharmacist has a key role to play in it. Surgical departments are particularly at risk, with a higher rate of unintended medication discrepancies (UMDs) found during medication reconciliation (MR) than in medical departments. An MR process prior to the pre-anaesthetic consultation (PAC) has been set up to improve the continuity of care for patients hospitalised in our vascular surgery department.
Aim and objectives The aim of our study was to assess the impact of carrying out proactive MR by a clinical pharmacist prior to the PAC versus retroactive MR.
Material and methods Proactive MRs were performed by a pharmacy intern and a pharmacy student, approximately 1 week before PACs. A telephone interview with the patient was carried out and then the retail pharmacy and/or primary care physician were contacted to collect the patient’s prescriptions. The best possible medication history (BPMH) form was given to the anaesthetist and registered into the patient’s medical record. Retroactive MRs were carried out, using the same sources, after the patient’s entry and after the first prescriptions.
Results Over a 6-month period, 200 MRs were performed in the vascular surgery department. 100 were proactive MRs and 100 were retroactive MRs. Concerning the populations, the average age was 66 years for proactive MRs versus 69 years for retroactive MRs, with 56% and 69% of men, respectively. The average number of home treatments was 7.4 (1–14) for proactive MRs and 8 (2–18) for retroactive MRs. As regards the UMDs found, there were 26 for the proactive MRs (ie, 0.26 UMD/patient). For retroactive MRs, there were 150 UMDs (ie, 1.55 UMD/patient).
Conclusion and relevance There are more than 5.5 times fewer UMDs when MRs are carried out proactively before the patient’s entry. Carrying out MRs for PACs enables the prescription to be anticipated and the anaesthetist to obtain an exhaustive list of the patient’s treatments, which also avoids forgetting to stop some of them, particularly anticoagulants. The development of prescription assistance software with a pre-prescription module would be a step forward and an added value for the reduction of medication errors.
Conflict of interest No conflict of interest