340 The Impact of Medicine Reconciliation by a Clinical Pharmacist Compared to Standard care for Elective Orthopaedic Admissions

Background Medicine reconciliation is defined as ‘The process of creating and maintaining the most accurate list possible of all medications a person is taking’. Medicine reconciliation (MR) is supported by various Irish governmental agencies such as the HSE, HIQA, PSI and the State Claims Agency. In addition, Irish GPs and community pharmacists are strongly in favour of expanding the role of hospital pharmacists in MR at all transitions in care. The aim of this study are to establish the appropriateness of the current MR service in elective surgical admissions in a Dublin based hospital. Methods This was a prospective interventional study that included 200 consecutive patients who met the inclusion criteria. The study was conducted between May and June 2018. All patients in the study received standard care in the control arm, followed by enhanced care in the interventional arm with errors noted and rectified after each process, this design allowed patients under standard care to act as a paired control group. Sub group analysis was performed on the following: (1) those >/= 65 years, (2) female patients, and (3) patients with a BMI > 30kg/m2. Ethical approval was obtained for this project. Results MR was found to detect a statistically significant number of errors compared to standard care (p=0.039). In the sub-group analysis, those >65 years (p=0.0237) or female (p=0.001), were at statistically higher risk of experiencing a MR error, verses obese patients (p=0.389). The Cornish classification tool was used to assess severity of the MR errors; while 37.5% of patients experienced at least one MR error, only between 1.5% - 3.5% of errors were classified as Class 3 errors. Conclusion A full medicine reconciliation service could be of benefit to targeted patients including those aged over 65 years or female, experiencing polypharmacy, or those with communication difficulties.