[Results of a medication reconciliation project in routine medical treatment after surgical discharge].
OBJECTIVE
To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence.


METHODS
Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems.


RESULTS
During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59.


CONCLUSIONS
Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence.
Servicio de Farmacia, Hospital Arnau de Vilanova, Valencia, España.
Santiago
S
Montesinos Ortí
Enrique
E
Soler Company
Amparo
A
Rocher Milla
Raúl
R
Ferrando Piqueres
Juan
J
Ruiz Del Castillo
Inmaculada
I
Ortiz Tarín
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies