Medication reconciliation procedures are required to minimise medication discrepancies and enhance patient safety. Integration of patient health records across care levels is necessary but not sufficient to prevent errors.

There was a high prevalence of REs among patients admitted to the surgical departments, most frequently the omission of a drug. The risk of an RE was higher in patients admitted for elective versus emergency surgery, as well as with the receipt of a larger number of drugs before admission.

Background Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. This study aimed to determine the clinical and ecological impact of an ASP for NHs. Methods We performed a cluster randomized controlled trial and a before-after study with interrupted time-series analyses in 14 NHs, for 30 consecutive months from July 2018 to December 2020, in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of five educational measures (general-ASP) and 7 added one-to-one educational interviews (experimental-ASP). The primary outcome was the overall use of antimicrobials, calculated monthly, as defined daily doses (DDD) per 1000 residents-day (DRD). Results During the ASP implementation, the total mean antimicrobial consumption decreased by 31.2% (-16.72 DRD; p = 0.045) with respect to the pre-intervention period; the overall use of quinolones and amoxicillin-clavulanic acid dropped by 52.2% (p = 0.001) and 42.5% (p = 0.006) respectively; and the overall prevalence of MDRO decreased from 24.7% to 17.4% (p = 0.012). During the intervention period, 12.5 educational interviews per doctor were done in the experimental ASP-group; no differences were found in the total mean antimicrobial use between groups (-14.62 DRD; p = 0.25) and two unexpected SARS-CoV-2 waves affected the participating centers with significant increases in the overall mean use of total antimicrobials of 40% (51.56 DRD; p < 0.0001). Conclusion This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDRO. This trial did not find benefits associated with educational interviews probably due to the COVID-19 pandemic.

The aim of the study was to evaluate the concordance among 10 anticholinergic scales for the measurement of anticholinergic drug exposure in at-risk elderly complex chronic patients in primary care.Methods: An 8-month cross-sectional, multicenter study was carried out in a cohort of complex chronic patients older than 65 years in treatment with at least 1 drug with anticholinergic activity. Demographic, pharmacological, and clinical data were collected. Anticholinergic burden and risk were detected using the 10 scales included on the anticholinergic burden calculator (http://www.anticholinergicscales.es/). We used κ statistics to evaluated the concordance 2 to 2 (according to risk: high, medium, low or without risk) among the included scales.Results: Four hundred seventy-three patients were recruited (60.3% female, median age of 84 years [interquartile range = 10]). Eighty was the total number of anticholinergic drugs with any scale (1197 prescriptions), with a median of 2 drugs with anticholinergic activity per patient (interquartile range = 2). The κ statistics comparing all the 10 scales ranged from −0.175 (Drug Burden Index versus Chew Scale) to 0.708 (Anticholinergic Activity Scale [AAS] versus Chew Scale). The best concordance was obtained between AAS and Chew Scale (κ = 0.708), followed by Clinician-Rated Anticholinergic Scale and Duran Scale (κ = 0.632) and AAS and Anticholinergic Cognitive Burden Scale (κ = 0.618), being considered substantial strengths of concordance. Conclusions:The agreement among the 10 scales in elderly patients with complex chronic conditions was highly variable. Great care should be taken when assessing anticholinergic drug exposure using existing scales because of the wide variability among them. The only scales that showed agreement were the AAS-Chew, Clinician-Rated Anticholinergic Scale-Duran, and AAS-Anticholinergic Cognitive Burden Scale pairs. In the rest of the cases, the scales are not interchangeable.

Background Medicines reconciliation processes have successfully reduced drug errors and adverse drug events. In a recent project in the Traumatology ward of our hospital, 59.3% of the patients had at least one unintended medicines discrepancy. Based on this experience The authors decided to implement medicines reconciliation (MR). Purpose To determine the number and type of pharmaceutical interventions performed after the implementation of the program. Materials and methods A prospective study carried out between October 2010-October 2011 in a tertiary care teaching hospital. All patients admitted to surgical wards were included. The authors excluded those who could not be interviewed due to language problems and those who were admitted at the weekend. The methodology used in the MR process is the following: within the 24 h of the patient's admission, the pharmacist obtains the preadmission chronic treatment by interviewing the patient or the patient's family/care giver, or from the patient's medical chart and primary care records. This is compared with the treatment prescribed in hospital. All of the discrepancies detected (dose, regimen, route of administration or omission) are discussed with the attending physician to determine whether it was intended in accordance with the patient's condition. If the discrepancy is unintended, appropriate changes are made to the medicines. Results Upon the implementation of MR, reconciliation was performed for a total of 1464 patients. The wards involved were: General Surgery (637), Traumatology (548), Urology (262) and Vascular Surgery (17). 1390 pharmaceutical interventions were performed, the most frequent being substitution for therapeutic equivalent (34.4%), adjustment of dose for renal insufficiency (24%), change to oral route (9.9%), omission of medicine (7.5%) or duration of treatment (5.5%), among others. The acceptance rate for our interventions was 91%. Conclusions An MR system was developed with the aim of continuity of treatment at each transition of care and preventing medicines errors.