title: Medication reconciliation for patients undergoing spinal surgery.
abstract: OBJECTIVE
  In recent years, a marked increase of spinal operations prompted a debate on quality issues. Besides obvious factors, such as the surgical technique, medication safety has been identified as one of the major risk factors for patients undergoing anesthesia and surgery. While the issue has already been addressed by hospital pharmacist and anesthesiologists, the prescription of correct medication remains within the surgeons' responsibility. We, therefore, investigated medication-related errors in spinal instrumentation patients and applied current medication reconciliation strategies.
  
  
  METHODS
  We performed a data survey on all patients undergoing spinal instrumentation in 2011. Risk factors for medication safety were identified and prioritized. Specific counter-measures were introduced in 2012 and evaluated in 2013.
  
  
  RESULTS
  147 patients were included in the 2011 and 162 in the 2013 survey. As top five risk factors we identified the preoperative stopping of medication, recording the medication history, prescription process of postoperative analgetics and anticoagulants and the medication list at discharge. Specific counter-measures included standardization of preparations, doses and the prescription process and improving access to this information (online and via a smartphone application). In elective patients, recording the medication histories was delegated to a hospital pharmacist and informative flyers and posters were used to integrate the patients themselves into the process. Counter-measures directed against the first four risk factors resulted in a significant reduction of medication errors. The last risk factor was targeted by instructing the responsible staff only, which proved to be a rather ineffective measure.
  
  
  CONCLUSIONS
  Medication safety could be significantly improved by implementation of counter-measures specific to the identified risk factors.
authors: Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
authors: Pamela
authors: P
authors: Kantelhardt
authors: Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
authors: Alf
authors: A
authors: Giese
authors: Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany. sven.kantelhardt@unimedizin-mainz.de.
authors: Sven R
authors: SR
authors: Kantelhardt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D057189:Checklist; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D063731:Mobile Applications; D019635:Neurosurgical Procedures; D010149:Postoperative Pain / Q000188:drug therapy; D010351:Patient Discharge; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D011182:Postoperative Care; D058996:Quality Improvement; D000068997:Smartphone; D013131:Spine / Q000601:surgery*; D055815:Young Adult
chemical_list: D000700:Analgesics; D000925:Anticoagulants
keywords: Hospital pharmacist; Medication reconciliation; Medication safety; Spinal instrumentation