[Results of a medication reconciliation project in routine medical treatment after surgical discharge]. / Resultados de un proyecto de control y adecuación del tratamiento médico habitual tras el alta quirúrgica.

OBJECTIVE: To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence. MATERIAL AND METHOD: Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems. RESULTS: During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59. CONCLUSIONS: Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence.

Resultados de un proyecto de control y adecuación del tratamiento médico habitual tras el alta quirúrgica / Results of a medication reconciliation project in routine medical treatment after surgical discharge

Objetivos. Reducir el número de problemas relacionados con la medicación asegurando la conciliación del tratamiento. Aumentar la comprensión y el cumplimiento del tratamiento del paciente. Material y método. Se obtiene la medicación ambulatoria del paciente mediante una entrevista personal y la revisión de su historia clínica y farmacoterapéutica. Se elabora un dossier que incluye información detallada de cada medicamento y un cronopictograma con las pautas posológicas. El día del alta se realiza una segunda entrevista con el paciente, donde se le informa oralmente y por escrito sobre todo su tratamiento. El proceso se valora mediante un cuestionario de satisfacción. A las 2 semanas del alta se realiza una encuesta telefónica para detectar problemas relacionados con la medicación posteriores al alta hospitalaria. Resultados. Durante el período de estudio (abril-diciembre de 2006) se incluyó a 544 pacientes. Se realizaron 658 intervenciones farmacéuticas; el 87%, educativas; el 5%, de eficacia, y el 8%, de seguridad. Se recuperaron 346 cuestionarios de satisfacción debidamente cumplimentados (el 63% de los repartidos). Las respuestas del cuestionario se puntúan de 0 (nada satisfecho) a 5 (muy satisfecho). Interés por la información recibida, 4,75; grado de comprensión de la información, 4,67; satisfacción con la intervención, 4,59. Conclusiones. La inclusión del farmacéutico en el equipo quirúrgico asegura la conciliación entre el tratamiento ambulatorio del paciente y el prescrito por el cirujano y disminuye los errores de medicación. Proporcionar información al paciente sobre su medicación en el momento del alta aumenta su comprensión del tratamiento farmacológico y su cumplimiento (AU)

Objective. To reduce the number of medication-related problems by ensuring reconciliation between ambulatory treatment and surgical prescription and to increase patients' understanding of drug therapy and treatment adherence. Material and method. Information on ambulatory medication was obtained through a personal interview and a review of the patient's personal and pharmacotherapeutic history. A dossier was created that included detailed information on each medication and a chronopictogram with all doses. On the day of discharge, a second interview with the patient was performed in which information was obtained orally and in writing about all treatment. The process was evaluated through a satisfaction questionnaire. Two weeks after discharge a telephone interview was carried out to detect post-discharge medication-related problems. Results. During the study period (April-December 2006) 544 patients were included. There were 658 pharmaceutical interventions: 87% educational, 8% safety, 5% efficiency. A total of 346 satisfaction questionnaires were properly completed (63% of those distributed). Responses to questionnaires were evaluated from 0 (completely dissatisfied) to 5 (highly satisfied). Interest in the information received was scored 4.75, understanding of the information 4.67, and satisfaction with the intervention 4.59. Conclusions. Including the pharmacist in the surgical team ensures reconciliation between ambulatory treatment and surgical prescription and reduces medication errors. Providing information to patients about their medication at discharge increases their understanding of drug treatment and adherence (AU)