[Medication reconciliation in patients over 75 years].
OBJECTIVE
To continue with the implementation of the medication reconciliation process on admission, and to analyse potentially inappropriate prescriptions according to the STOPP-START -Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right (indicated) Treatment- criteria, and drug interactions. To extend the process of reconciliation at hospital discharge from the Cardiology and Chest Diseases departments.


METHODS
Retrospective observational study that included patients over 75 years old. The "Consensus Document on Terminology and Classification in Medication Reconciliation" was used for the classification of the discrepancies found. Potentially inappropriate prescriptions and drug interactions were reviewed. For reconciliation at discharge, a "Drug information program at discharge" leaflet and a "Patient information sheet" was developed.


RESULTS
The number of reconciled patients was 818, with a level of coverage of 42.3% (target patients: 1,932). Reconciliation errors by patient were 23.4% (191) on admission and 22.5% (9) at discharge. All patients who were reconciled at discharge were given the "Drug information program at discharge" leaflet. Potentially inappropriate prescriptions, according to STOPP/START criteria, affected 6.0% (49) of reconciled patients. The number of clinically relevant interactions affected 11.7% (96) of patients.


CONCLUSIONS
The implementation of a reconciliation process has detected the existence of errors between chronic and prescribed treatment in the hospital. The STOPP/START criteria applied to this group of patients have helped to find out the most common potentially inappropriate prescriptions. The analysis of drug interactions shows drug combinations that should be avoided in these patients.
Servicio de Farmacia, Hospital Universitario de Móstoles, Móstoles, Madrid, España. Electronic address: beatriz.rubio@salud.madrid.org.
B
B
Rubio-Cebrián
Servicio de Farmacia, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
I
I
Santaolalla-García
Servicio de Farmacia, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
I
I
Martín-Casasempere
Servicio de Farmacia, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
M
M
Segura-Bedmar
D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions; D006769:Hospitals, General; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation / Q000379:methods / Q000458:organization & administration; D010351:Patient Discharge; D010353:Patient Education as Topic; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D012189:Retrospective Studies
Aged patient; Conciliación de medicamentos; Drug interactions; Inappropriate prescribing; Interacciones medicamentosas; Medication reconciliation; Paciente anciano; Patient safety; Prescripción inapropiada; Seguridad del paciente