Pharmaceutical intervention for medication reconciliation at admission in a department of orthopaedic surgery and traumatology. Analysis of avoided costs

Objectives: To identify, classify and intervene on unjustified discrepancies found between the patient’s home medication and medication prescribed at hospital admission.It also aims to identify the variables associated with the presence of medication errors and determine the health cost avoided by reducing medicationrelated problems. Method: Prospective experimental intervention study developed for five months at the Department of Orthopaedic Surgery and Traumatology of a tertiary hospital. All patients over 16 years of age, with a minimum stay of 24 hours who gave their consent were included. A hospital pharmacist intervened on all unjustified discrepancies ?UD? detected, classifying according to the criteria defined by The National Coordinating Council for Medication Error Reporting and Prevention ?NCCMERP?. The severity of these discrepancies was related to increased risk of hospital length of stay, to estimate the avoided cost following the criteria of Bates et al. The study of variables associated with discrepancies was performed using binary logistic regression, incorporating the variables signi?cantly associated in the bivariate analysis. Results: 196 patients were included, 59.2% women, mean age 65.5 ±17.45 years old. The most common admission diagnosis was fracture 3??9.8?%? followed by osteoarthritis ?23?%?. Patients had a mean of 2.63? ±1.8?2 comorbidities, with 4.91 ±? 3.7 home medication. ??382 discrepancies (?1.95 discrepancies/patient)? were detected,of which 51.04% were not justified, most due to omission of medication ??37%? and incomplete prescriptions ??32%?. We intervened at all unjustified discrepancies detected, obtaining a degree of acceptance higher than 96%. Was estimated a health cost avoided of €123?,652.8. A model of five variables was established,all with statistical significance ?(p