Resumen de Medication reconciliation in postoperative patients after orthopaedic surgery
Margarita Beltrán García, María Dolores Guerrero Aznar, M. Ferrit Martín, Ana Conde Albarracín, Juan Antonio Fuentes Agudo
Introduction: The medication reconciliation is a complex process in which reconciliation errors occur or unjustified discrepancies of high risk with a highly variable incidence. The objective is to detect and analyse the reconciliation errors detected, as well as the impact of pharmaceutical interventions aimed at preventing possible reconciliation errors after 48 hours of the postoperative period in patients undergoing orthopaedic surgery.
Method: We performed a prospective observational study in March 2012 at a third level hospital.We selected patients older than 60 years, scheduled for orthopaedic surgery and with a number of chronic medications prescribed >1. We obtained information about chronic medication and after 48 hours of the orthopaedic postoperative through electronic prescribing system and this was confirmed after interviewing the patient. Pharmaceutical intervention consisted of updating the prescription profle of the patient's medication or drug-related recommendations to medical practitioners.
Results: We reviewed a total of 188 patients and 38% were selected. We detected a total of 180 unjustified discrepancies out of the 414 chronic drugs prescribed 43.5%. We detected reconciliation errors in 87.3% of patients. The distribution according to type was: omission 70.5% no drug interruption 15.5% and duplication 13.8% according to severity was: required monitoring of medication to prevent damage 75% would not have caused damage 22% and caused damage 2.8%. The pharmaceutical interventions were 91.6% to update the profile of prescription and the 8.3% recommendation to the medical practitioner. Acceptance of interventions was 7.2%.
Conclusions: The high percentage of reconciliation errors detected requiring medication monitoring and pharmaceutical recommendations to prevent damage to the patient refects the importance of reconciliation in the postoperative period following orthopaedic surgery as part of the daily activity of the pharmacist integrated into the multidisciplinary team caring for the patient
