Implementation of medication reconciliation activity in a geriatric hospital in France: feedback from Dupuytren hospital pharmacy

Abstract

Medication reconciliation reduces dispensation errors and guarantees a quality care pathway, particularly at community hospital transition points. In a geriatric hospital, we have implemented medication reconciliation in two services, in a geronto-psychiatry unit and in a follow-up and rehabilitation care unit. The study was initially carried out in 2012 over 3 months in the follow-up and rehabilitation care unit and in 2022 over 12 months in the geronto-psychiatry unit and was based on patients hospitalized different treatments at the transition points (admission and stay).
Information collection on patient as well as his or her community treatment was carried out by consulting the medical file, interviewing the patient and/or family, collecting the prescriptions brought in, and contacting the attending physicians and pharmacists.
In 2012, 44 patients, 349 lines of prescriptions, 406 modifications called discrepancies were made: 36.9% were additions, 31.5% were interruptions, 19.5% were substitutions and 12% were posology changes. These deviations were either intentional or unintentional, and 5 potentially serious medication errors, i.e. 1.23% of the deviations, were detected. These were mainly one addition, three omissions and one dosage change. These discrepancies were either intentional or unintentional. Five potentially serious medicationerrors, i.e. 1.23% of discrepancies, were detected. These were mainly one addition, three omissions and one posology changes.
In 2022, there were 47 patients, 564 prescription lines, 119 intentional discrepancies and 29 unintentional discrepancies, i.e. 148 discrepancies in total, with 5 potentially serious medication errors (one discontinuation, three omissions and one change in dosage), i.e. 3.38% of discrepancies.
Medication reconciliation allowed to reduce prescription discrepancies and to improve treatment continuity and quality for elderly hospitalized patients in a context of multidisciplinary involvement and improved geriatrician-pharmacist collaboration.