4CPS-241 Proactive versus retroactive models in medication reconciliation – are there benefits?

<h3>Background and Importance</h3> The practice of medication reconciliation (MR) at admission, by hospital pharmacists, has been growing in our country, aiming to reduce drug related problems (DRP). However, its implementation mainly focuses on the retroactive model, with limited data on the proactive model. <h3>Aim and Objectives</h3> This study aims to characterise and compare retroactive and proactive MR processes, particularly regarding the number of unintentional discrepancies (UD) that can lead to DRPs. To explore the relationship between each model and the average length of hospital stay per patient. To investigate the connection between both models and the admission waiting list, when compared to the waiting list prior to the implementation of MR. <h3>Material and Methods</h3> A prospective study was conducted in a vascular surgery unit from October 2023 to September 2024. Inclusion criteria: presence of comorbidities, age ≥55 years, and prior chronic therapy with ≥5 drugs. Model classification, depending on prescription availability when medication history was ready. Data collection and analysis were done using Microsoft Excel. <h3>Results</h3> The study included 502 patients (average age 71.1 years), with 3540 drugs reconciled using the retroactive model (233 MRs) and 3571 drugs with the proactive model (269 MRs). In retroactive MR, 775 (21.9%) UDs and 8 (0.2%) unjustified intentional discrepancies (UID) were identified, compared to only 29 (0.8%) UD and five (0.1%) UID in the proactive model. Among these, 772 (98.6%) and 27 (79.4%) pharmaceutical interventions (PI) were accepted by physicians, respectively. The most common causes of UD and UID were drug omission (58.9% vs 67.6%) and incorrect drug dosage (15.9% vs 9.1%). The average length of stay from October 2022 to September 2023 was 7.1 days. In this study, retroactive MR cases averaged 7.4 days (SD=13.9), while proactive cases averaged 4.7 days (SD=8.9). Before MR implementation, the waiting list for admission (March 2023) was 128 patients, decreasing to 108 by September 2024. <h3>Conclusion and Relevance</h3> The proactive MR model demonstrated benefits over the retroactive model in early prevention of UDs capable of leading to DRPs, shorter hospital stays, and greater patient recovery, suggesting better bed availability. Overall, MR and PI may have contributed to reduced treatment waiting lists, though further monitoring is needed to strengthen these findings. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest