5PSQ-136 A pharmaceutical care programme in patients undergoing cardiac surgery

Background The preoperative setting is an area with high risk for medication errors with potentially severe consequences. Strategies to reduce the incidence of medication errors are needed to guarantee the safety of these patients. Purpose To describe the implementation of a pharmaceutical care programme (PCP) in patients undergoing cardiac surgery and its results in preventing medication errors. Material and methods The comprehensive PCP was implemented in July 2018. Telephonic pharmacists’ clinical interviews took place the week prior to cardiac surgery. Patients’ complete medication list including over the counter and herbal products was compiled during the interview and medical instructions for adequate preoperative drug management were reinforced. Patients were admitted to the hospital at least 36 hours before the surgery, where medication management was supervised by ward personnel. At the time of admission, the ward pharmacist performed the medication reconciliation and suggested any further adjustments deemed necessary. Observational prospective study. Time of study: July 2018 to September 2018. Pharmacists’ interventions classified according to Overhage classification and the severity of medication errors accordingto NCC MERP were analysed. Results Fifty-one patients were included, mean age 67.7 years, 60.8% males. Patients received an average of 7.1 (SD 3.1) chronic drugs. Forty patients (78.4%) were taking drugs that needed to be discontinued before surgery. Nineteen patients (37.3%) were on anticoagulants and 19 were taking antiplatelet drugs. Pre-operative drug management was correct in all cases. Thirty-eight pharmacist interventions were made at the time of admission, classified as: wrong dose (47.4%), drug omission (31.6%), wrong frequency of administration (10.5%), wrong drug (7.9%) and wrong dosage form (2.6%). Overall acceptance of pharmacy interventions was 89.5%. According to the severity of medication errors, 30 (78.9%) errors were serious (E/F), and eight (21.1%) classified as error without harm (C/D). Regarding health outcomes, no surgeries had to be postponed due to wrong perioperative medication management. The mean length of hospital stay was 16 days (2–60). The readmission rate at 30 days was 3.9% (n=2). Conclusion The PCP in patients undergoing cardiac surgery was successfully implemented, ensuring a correct preoperative drug management. We intercepted 0.8 medication errors per patient included in the programme. The errors were mostly serious. References and/or acknowledgements No conflict of interest.