4CPS-160 Improving patient safety: the clinical impact of medication reconciliation at admission in trauma and orthopaedic surgery

<h3>Background and Importance</h3> Transitions in patient care, such as hospital admissions, discharges, or interdepartmental transfers, are high-risk periods for medication errors that can lead to preventable adverse drug events (ADEs). These errors in medication regimens can significantly compromise patient safety, especially in surgical departments where the risk is amplified by factors such as the use of high-risk medications (e.g., anticoagulants, analgesics), frequent changes in treatment plans pre- and post-operatively, and the complex coordination required between different healthcare professionals. <h3>Aim and Objectives</h3> This study aimed to evaluate the prevalence and types of unintentional discrepancies (UIDs) in the medications of patients admitted to an Orthopaedic Surgery and Trauma Department. It also assessed the clinical impact of pharmaceutical interventions related to these UIDs through medication reconciliation conducted by a pharmacist upon admission. <h3>Material and Methods</h3> This cross-sectional single-centre study was conducted over two periods: July 21–November 5, 2021, and October 20, 2022–August 24, 2023. Eligible patients were adults at medication risk, admitted to the Orthopaedics and Trauma Surgery Department of a Swiss tertiary hospital. Medication reconciliation was done by a pharmacist on admission using three sources to identify discrepancies between the Best Possible Medication History and admission prescriptions. Discrepancies were classified as intentional or unintentional based on medical records and, if needed, a discussion with the physician. A pharmaceutical intervention was conducted for each unintentional discrepancy. The clinical impact of each intervention was assessed by a panel of experts (orthopaedic surgeon, internal medicine physician, and clinical pharmacist) using the CLEO scale (French Society of Clinical Pharmacy tool). <h3>Results</h3> A total of 237 patients were included. At admission, 67% had at least one UID. Of the 385 UIDs identified, the most common were unintentional omissions (66%) and changes in dosage or frequency (27%). 92% of the proposed pharmaceutical interventions concerning these UIDs were accepted by the attending physicians during hospitalisation. Pharmaceutical interventions had a major clinical impact in 9%, moderate in 26%, and minor in 40%. Good agreement was observed between the expert raters. <h3>Conclusion and Relevance</h3> This study underscores the significant value of medication reconciliation in the Orthopaedics and Trauma Surgery Department to reduce the frequency of medication errors and enhance patient safety. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest