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The action of the pharmacist, as part of the multidisciplinary team, resolved the discrepancies in the medication on admitting the patients selected.

Background A treatment exchange protocol (TEP) contains three ways of intervening: a) suspend the prescribed treatment (not very useful), b) keep the patient on his home medicines during the hospitalisation, c) exchange the treatment (TE) to another drug included in the hospital formulary. The protocol used not to be applied to multidose drugs commonly used by patients. Purpose To assess the prescription of drugs not included in the hospital formulary (NIDHF) and to know the acceptability of recommendations for a change of treatment. Materials and methods Observational, prospective, two-month study in a General Hospital. Every day The authors recorded new NIDHF prescriptions, age, sex and diagnosis. TEP was applied to everyone. When the recommendation wasn't accepted, The authors recorded the reason (eg, allergy). NIDHFs without a recommendation because of a lack of evaluation or agreement were quantified, knowing they were a therapeutic void in the hospital formulary (HF) and TEP. Results The authors identified 251 NIDHFs from 209 patients (average age 66, 46% male). The authors obtained an average of six new prescriptions daily; half of them were replaced according to the TEP. The analysis of the non-replaced NIDHF drugs was: 46% of NIDHF drugs were kept during hospitalisation. They were mainly oral antidiabetic and antidementia agents. In 12% the drug was acquired occasionally for a justified reason. In 7% they were multidose drugs. In 18% the TE was rejected. In 9% the TE wasn't available. In the remainder, the reason for rejection wasn't specified and patients provided treatment. Clinical services with more NIDHF prescriptions were: Internal Medicine (40%) and Traumatology (10%). The lowest acceptance of recommendations was in Home Hospitalisation (45%) and Surgery (33%). The greatest number of prescriptions for drugs without agreed therapeutic exchange was in Pneumology (23%) and Otorhinolaryngology (28%). Conclusions The adherence to the HF and acceptance of the TEP recommendations were high. Many of the requirements of NIDHF are solved with TEP. The study has enabled us to detect therapeutic areas in which the HF and TEP could be improved. Any changes must be reviewed and agreed with medical services to reduce the likelihood of adverse events and promote good-quality pharmacotherapy.

Introduction:Life expectancy for individuals with schizophrenia is 20% lower than in general population. Medical illnesses, psychiatric comorbidities, less access to care, poverty and limited perception of illness are some of the most important factors associated with increased risk of morbidity. Cardiovascular death (CVD) is a major contributor to increased mortality in schizophrenia 2,3. Prevalence of obesity in patients with schizophrenia (40%-60%) is twice the rate of the general population (20%-30%). Obesity, high abdominal perimeter, serum lipid levels, and smoking are significant, Independent Risk Factors for CVD.Metabolic syndrome is a cluster of metabolic disturbances, which is associated with an increased risk of CVD.Objective:To estimate the prevalence of CVRF in schizophrenic outpatients treated at Granollers' CSM.Methods:Cross-sectional descriptive study about 100 schizophrenic outpatients treated at CSM Granollers. Data on sociodemographics, physical examinations, blood test parameters, CVRF history and treatments are recorded. Each CVRF is established according to international criteria and/or pharmacological treatment.Secondary objectives:•Prevalence of Metabolic Syndrome;•Antipsychotic drugs treatment.Variables - Sociodemographic data and Schizophrenia diagnosis:•Physical examination;•Lab parameters;•Other CV risk factors (smoking, alcohol intake…).Results and conlusions:Estimated prevalences for most of the CVRF in schizophrenic outpatients are, in general, higher than those expected of the same age group in the general population. Data presented can support therapeutic decision-making and suggests a need of new prevention and monitoring strategies. New guidelines for monitoring and intervention will be needed for monitoring and intervention.

Background Elderly patients are likely to be served by different health professionals with the consequent appearance of polypharmacy, increased risk of adverse drug reactions and increased hospital admissions. Therefore, we consider this population candidates for a medicines reconciliation process. PurposeTo identify the type, frequency and severity of discrepancies between the medicines prescribed during admission and their chronic medicines and to investigate medicines involved in reconciliation errors. Materials and MethodsRetrospective and descriptive study conducted in a general hospital from November to December 2011. A pharmacist reviewed the treatments 24 hours after hospitalisation, comparing the prescription for medicines sent to the pharmacy with the clinical history and patient interview. Discrepancies were classified according to the consensus document on terminology, classification and assessment of the reconciliation programmes, and severity according to the NCCMERP index. Results192 patients were analysed, the median age of patients was 84.3 years (SD: 5.7) of whom 56.3% were women. 98.4% took medicines chronically (7.4 medicines/patient). 563 discrepancies were detected in 170 patients (88.5%): 372 discrepancies did not require clarification and 191 discrepancies required clarification with the physician. Among the discrepancies requiring clarification, 37.7% were accepted by the physician as reconciliation errors (REs). Most were due to the omission of the patient’s chronic treatment. Most REs were associated with cardiovascular drugs, nervous system drugs and gastrointestinal drugs. The severity of RE was mostly classified within category C but 30.6% had category D and 4.2% had category E (potential harm). Conclusions The reconciliation process has detected the existence of discrepancies in patients older than 75 years. Special attention should be paid to drugs belonging to the cardiovascular system, nervous system and the digestive system. Most REs would probably not have caused damage but more than 30% had category D and E. No conflict of interest.