PS-049 Medicines reconciliation in an inpatient oncology unit

Background As cancer is often life-threatening, medicines reconciliation is particularly important as cancer patients transition between different levels of the health system. Purpose The primary objective was to determine the frequency and type of medicines reconciliation discrepancies upon admission to the oncology unit. Secondary objectives were to assess the effectiveness of pharmacist interventions on medicines reconciliation discrepancies and to identify factors that may affect the frequency of errors. Materials and methods This was a prospective, single-centre study of patients taking at least one medicine who were admitted to the oncology unit. Medicines reconciliation was conducted by a pharmacist who gathered information by checking the patients’ home medicines, patient and caregiver interviews and confirming the medicines list with community pharmacy records. The resultant list was compared against medicines documented in the electronic medical record to identify any discrepancies. The frequency, type, and reason for medicines discrepancies were assessed together with demographic variables. Results Fourteen patients were interviewed, 66.6% were men. The mean age was 66 years. The admission complications were: pulmonary (14.3%), digestive (14.3%), haematological (14.3%), pain (21.4%) and chemotherapy administration (35.7%). Of 14 patients interviewed, all had at least one discrepancy. The pharmacist performed 83 interventions (to correct 84.3% omission, 7.2% therapeutic duplications, 8.4% wrong route, frequency or dose). They were accepted by doctors in 44 cases (53%). Three patients did not have any medicines list recorded in the e-prescribing program during hospitalisation. The mean number of medicines the patients were taking before the process was 8. Patients taking three or more drugs were found to have the most discrepancies. Conclusions The most common medicines reconciliation discrepancies were omission errors. Omission errors and moderate acceptance of interventions were attributed to the oncologists not using the e-prescribing program when the length of hospital stay is short, for example when patients are admitted for administration of chemotherapy. No conflict of interest.