4CPS-258 Medication reconciliation programme in neurosurgery

Background Medication is the leading cause of adverse events related to healthcare. One of the most common safety issues is the lack of accurate and complete information about a patient’s medications during transitions between different levels of care. Purpose To characterise and evaluate the impact of the implementation of a Medication Reconciliation Programmed (MRP) on the neurosurgery service at a university general hospital. Material and methods Retrospective study between September 2014 and September 2016 in a university general hospital. The MRP is performed by the pharmacist when the patient is admitted to the neurosurgery department and requested. Home treatment is reviewed from the digital pharmacotherapeutic history and confirmed with the patient by interview. After that, the pharmacist makes recommendations according to the clinical situation of the patient, the drugs already prescribed in their hospital treatment and the ‘Guide to continuity of care for the management of perioperative medication’ developed by the pharmacy service. These recommendations are recorded in each patient’s medical history. When the patient is discharged, a pharmacotherapeutic report is drawn up containing the medication prescribed for discharge and the outpatient medication, which must be continued as a schedule and with identifying illustrations. In order to evaluate the activity of the PCM, it has been measured: patient data, drug-related problems (DRP) identified, days spent in hospital, number of reconciled drugs and intervention carried out (continuation, suspension or therapeutic exchange). Results During the study period, the pharmacy service reconciled the treatment of 54 neurosurgery patients. The average age of the patients was 65±14 years. The median hospital stay was 5 days (1–30). The number of reconciled drugs was 337, with an average of 6±3 drugs per patient. According to the guide previously mentioned, pharmaceutical interventions were: 49% continue with the usual treatment, 40% discontinue usual treatment during hospitalisation and 11% required therapeutic interchange. Finally, two DRPs were detected and resolved. Conclusion Patients hospitalised in the neurosurgery service can find benefit with MRP performed by pharmacists, ensuring an adequate pharmacotherapeutic approach between the different levels of healthcare. References and/or Acknowledgements Neurosurgery service. Pharmacy service. No conflict of interest