[Medication reconciliation in patients over 75 years]. / Conciliación de la medicación en pacientes mayores de 75 años.

OBJECTIVE: To continue with the implementation of the medication reconciliation process on admission, and to analyse potentially inappropriate prescriptions according to the STOPP-START -Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right (indicated) Treatment- criteria, and drug interactions. To extend the process of reconciliation at hospital discharge from the Cardiology and Chest Diseases departments. MATERIAL AND METHODS: Retrospective observational study that included patients over 75 years old. The "Consensus Document on Terminology and Classification in Medication Reconciliation" was used for the classification of the discrepancies found. Potentially inappropriate prescriptions and drug interactions were reviewed. For reconciliation at discharge, a "Drug information program at discharge" leaflet and a "Patient information sheet" was developed. RESULTS: The number of reconciled patients was 818, with a level of coverage of 42.3% (target patients: 1,932). Reconciliation errors by patient were 23.4% (191) on admission and 22.5% (9) at discharge. All patients who were reconciled at discharge were given the "Drug information program at discharge" leaflet. Potentially inappropriate prescriptions, according to STOPP/START criteria, affected 6.0% (49) of reconciled patients. The number of clinically relevant interactions affected 11.7% (96) of patients. CONCLUSIONS: The implementation of a reconciliation process has detected the existence of errors between chronic and prescribed treatment in the hospital. The STOPP/START criteria applied to this group of patients have helped to find out the most common potentially inappropriate prescriptions. The analysis of drug interactions shows drug combinations that should be avoided in these patients.

Conciliación de la medicación en pacientes mayores de 75 años / Medication reconciliation in patients over 75 years

Objetivo. Continuar con la implementación del proceso de conciliación de medicación al ingreso y analizar las prescripciones potencialmente inapropiadas según criterios STOPP/START -Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right indicated Treatment- y las interacciones farmacológicas. Ampliar el proceso de conciliación al alta hospitalaria en los servicios de Cardiología y Neumología. Material y métodos. Estudio observacional, descriptivo y retrospectivo que incluyó pacientes mayores de 75 años. Para la clasificación de las discrepancias encontradas se utilizó el ‘Documento de Consenso en Terminología y Clasificación en Conciliación de la Medicación’. Se revisaron las prescripciones potencialmente inadecuadas y las interacciones farmacológicas. Para la conciliación al alta se elaboró el tríptico ‘Programa de información de medicamentos al alta hospitalaria’ y la ‘Hoja de información al paciente’. Resultados. El número de pacientes conciliados fue 818, siendo el grado de cobertura del 42,3% (población diana: 1.932). Los errores de conciliación detectados por paciente fueron 23,4% (191) en el ingreso y 22,5% (9) al alta. A todos los pacientes conciliados al alta se les entregó la hoja de información en dicho momento. Las prescripciones potencialmente inadecuadas según criterios STOPP/START afectaron al 6,0% (49) de los pacientes conciliados. El número de interacciones con repercusión clínica afectó al 11,7% (96) de los pacientes. Conclusiones. La inclusión del proceso de conciliación ha permitido detectar la existencia de errores entre el tratamiento crónico y el prescrito en el hospital. Los criterios STOPP/START aplicados a este grupo de pacientes han permitido conocer las prescripciones potencialmente inadecuadas más frecuentes. El análisis de las interacciones farmacológicas muestra las combinaciones de fármacos que deben ser evitadas en estos pacientes (AU)

Objective. To continue with the implementation of the medication reconciliation process on admission, and to analyse potentially inappropriate prescriptions according to the STOPP-START -Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right (indicated) Treatment- criteria, and drug interactions. To extend the process of reconciliation at hospital discharge from the Cardiology and Chest Diseases departments. Material and methods. Retrospective observational study that included patients over 75 years old. The ‘Consensus Document on Terminology and Classification in Medication Reconciliation’ was used for the classification of the discrepancies found. Potentially inappropriate prescriptions and drug interactions were reviewed. For reconciliation at discharge, a ‘Drug information program at discharge’ leaflet and a ‘Patient information sheet’ was developed. Results. The number of reconciled patients was 818, with a level of coverage of 42.3% (target patients: 1,932). Reconciliation errors by patient were 23.4% (191) on admission and 22.5% (9) at discharge. All patients who were reconciled at discharge were given the ‘Drug information program at discharge’ leaflet. Potentially inappropriate prescriptions, according to STOPP/START criteria, affected 6.0% (49) of reconciled patients. The number of clinically relevant interactions affected 11.7% (96) of patients. Conclusions. The implementation of a reconciliation process has detected the existence of errors between chronic and prescribed treatment in the hospital. The STOPP/START criteria applied to this group of patients have helped to find out the most common potentially inappropriate prescriptions. The analysis of drug interactions shows drug combinations that should be avoided in these patients (AU)