An admission medication reconciliation programme carried out by pharmacists: impact on surgeons' prescriptions

Abstract

Objectives To describe a medication reconciliation (MR) procedure prepared by the pharmacist for patients admitted for elective surgery and to assess the surgeon's degree of acceptance.Methods A 1-year retrospective observational study was conducted. The patient population consisted of patients aged 18 years admitted during 2016 for elective surgery and whose planned length of hospital stay was >24hours. A pharmacist performed MR following a specific protocol. A review of the reconciliations prescribed later by the surgeons was conducted. Statistical analyses were performed for qualitative and quantitative variables.Results The pharmacist prepared a total of 1986 reconciliation reports. The 179 patients reviewed in this study had a mean age of 65.711.8 years, 49.2% were women and 98.9% of patients were reconciled by the surgeon in the operating theatre using an electronic prescribing system (85.5% were fully reconciled).Conclusion The hospital's MR protocol resulted in almost 100% of patients being reconciled within the subgroup of elective surgery patients by the prescribing surgeons.