Article Text

Download PDFPDF

5PSQ-030 Concordance of medication prescription records in the hospitalised surgical patient
  1. O Guillen Martinez,
  2. M Rodriguez Morote,
  3. MJ Lucas Mayol,
  4. C Matoses Chirivella,
  5. S Gutierrez Palomo,
  6. A Navarro Ruiz
  1. Hospital General Universitario de Elche, Servicio de Farmacia, Elche, Spain


Background and Importance Electronic prescriptions allow pharmacists to communicate with the rest of the multidisciplinary team, facilitate pharmacotherapeutic monitoring.

Aim and Objectives Assess the reliability of electronic prescription by analysing concordance, the presence or absence of discrepancy, by studying the active medication in these prescriptions and the pharmacist’s interview with the patient and/or caregiver.

Material and Methods Retrospective observational study carried out in a third-level general hospital. During a period of 12 months, all patients belonging to the Traumatology, Urology and Neurosurgery Service in whom the responsible physician indicated medication reconciliation by the Pharmacy Service were included. Demographic variables (sex, age), pharmacotherapeutic variables (treatment lines reviewed, total number of drugs (F) prescribed and not prescribed, cause of discordance (F prescribed but the patient is not on current treatment, changes in dosage), occasional consumption, F not prescribed), presence or not of polypharmacy (5 or > medications), majority ATC classification of discordant drugs).

Results 378 patients were analysed,169 men (44.7%) and 209 women (55.3%), with a mean age of 69 years [11.8] and 71 years [11.6], respectively. It was observed that 60.6% of patients presented at least one discrepancy in the treatment reflected in the electronic prescription. The pharmacist reviewed 2426 prescribed lines of treatment and 401 discordant drugs were detected: 98 (24.5%) drugs not prescribed, 187 (47%) drugs prescribed but that the patient does not take, 75 (18.5%) drugs with changes in the dosage regimen not reflected in the prescription, 41(10%) drugs with occasional consumption. The presence or absence of polypharmacy was evaluated stratified by sex: 110 men (65%) and 130 women( 62%). In turn, age ranges were established, observing the presence of polypharmacy in the population of 61–80 years with an average of six drugs and 81–100 years with an average of eight drugs. Finally, it was studied that the majority ATC group of drugs that the patient did not take despite being prescribed, was group N, highlighting benzodiazepines, antidepressants and antiepileptics. The majority of ATC group of drugs not prescribed but that the patient did take were group A, highlighting proton pump inhibitors, vitamin D, calcium and magnesium; and group C, mostly statins, angiotensin II receptor antagonists, ACE inhibitors and beta blockers.

Conclusion and Relevance In view of the results obtained and the high percentage of patients (60.6%) in whom a discrepancy is found in the electronic prescription, it would be advisable to extrapolate the pharmaceutical action carried out in the Traumatology, Urology and Neurosurgery services to all the hospital’s clinical services in order to avoid possible medication errors and adverse effects.

Conflict of Interest No conflict of interest.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.