5PSQ-158 Interest in medication reconciliation and establishment of a prioritisation score in a vascular surgery department

BackgroundPatients in the vascular surgery department (VSD) are under several medications, with a high risk of medication error. Medication reconciliation (MR) could help to prevent the risk of a drug iatrogenic issue. Checking the whole admission prescriptions is difficult for pharmacists because of high turnover in the surgery department. Patients with a high-risk error in admission prescription had to be identified.PurposeThe aim of this study was to evaluate the interest of MR in a VSD and to identify a prioritisation score to target patients who should benefit from MR.Material and methodsThis study was conducted between February and September 2018. Several sources were collected to identify a list of patients’ current medications, by one pharmacist. Comparing this list with hospital prescriptions allowed the identification of divergences. Three classes of divergences were identified: intentional with notification, intentional without notification and unintentional (UD). For each patient included, a prioritisation score was calculated based on age, number of drugs, comorbidities and different therapeutic class prescribed. A threshold of this score was searched to target the patients with high risk of UD. A Chi2 test was used to find an association between the score and the presence of UD.ResultsDuring this period, 2720 patients were hospitalised in the VSD, with a mean number of patients admitted per day of 12 (min=1; max=22). Among these patients, 233 patients (9%) benefited from MR. Among these patients, 34% had at least one UD. For these patients, the mean number of medications on admission was nine. Among the 145 UD identified, the main reason for UD was omission (30%) and the most frequent medication was antihypertensive (10%). The median prioritisation score of patients with UD and without UD were, respectively, 11 and 9. There was a significant association between the score ≥11 and UD presence (p