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4CPS-103 Improving medication reconciliation reports: evaluation through quality audits
  1. MI Sáez Rodríguez,
  2. C López Gómez,
  3. JJ Arenas Villafranca,
  4. M Miranda Magaña,
  5. B Tortajada Goitia
  1. Costa del Sol Hospital, Pharmacy, Marbella, Spain


Background and importance Medication reconciliation (MR) before a scheduled surgical procedure (SSP) improves patient safety, but the quality of this process must be taken into account. In our centre, the MR protocol includes hospital pharmacists’ reports (RR) that encourage the process.

Aim and objectives Evaluate the evolution of quality of pharmacists’ MR reports after annual audits.

Material and methods The study was performed in a 350-bed hospital.

According to MR protocol, before a SSP a pharmacist prepares an MR report that contains patients’ data, medical service, the medications or dietary supplements that they take (active ingredient, dose, posology), and an individualised MR proposal for surgeons to adapt their medication during hospitalisation, according to availability of drugs and adequacy of prescription. MR proposals can be ‘mantain’, ‘suspend’, ‘evaluate’ or ‘replace for’.

Subsequently, another protocol was developed to evaluate the quality of the MR report. Five relevant items were selected: item I: percentage of reports with empty medication list; II: percentage of reports with at least one item from column ‘medication’ written by commercial name; III: percentage of reports with at least one item from column ‘medication’ empty; IV: percentage of reports with at least one item from column ‘dosing’ empty; V: percentage of reports with at least one item from column ‘reconciliation proposal’ empty. Results were considered optimal if item errors were ≤10% and excellent if ≤5%. From 2016 to 2019 an audit was carried out annually, selecting a random sample of 30 patients and establishing an annual improvement plan according to the results (Table 1).

The improvement proposals established for each year were: 2016, include a week rotation in the reconciliation area for the first-year resident; 2017, extend MR rotation of the third-year resident from 2 to 5 months; 2018, establish a supervision/review circuit by the reference pharmacist of the RRs performed.

Abstract 4CPS-103 Table 1


Conclusion and relevance After each improvement proposal introduced, especially the review of the RRs, an improvement in the quality of the RRs was observed over the years. After the last audit, all the indicators were at excellent levels of achievement.

Conflict of interest No conflict of interest

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