Background and Objective: Providing proper medication management of oral pharmaceutical dosage forms for patients with Percutaneous endoscopic gastrostomy (PEG) is a challenge, therefore this study was conducted to identify the need for pharmaceutical reviews in the context of PEG insertion and the need for medication review. The objective of this study was to identify patients who are on inappropriate medication for PEG insertion and what these medications are, by mapping the medication taken by patients before and after PEG insertion.  Method: A quantitative study with analysis of retrospective data. The project included 99 patients who had undergone a PEG surgery between 2017 and 2021, at one of the hospitals in Gävleborg.The study was conducted using data from Cyklop, a program that Region Gävleborg can use to produce statistics for health care. The statistical measures used to describe the data were mean, percent, 95% confidence interval and standard deviation. Setting: The hospital in Gävle.  Main outcome measures: The number of patients who remained on potentially inappropriate medications after the PEG insertion and the number of patients who received a changed medication list after the insertion. Results:  A total of 99 patients undergoing PEG surgery were included. The majority of the patients 56% (n = 55) remained on potentially inappropriate drugs after PEG, 27,3% (n = 27) of which had remained partially on inappropriate drugs and had some prescription changes after PEG.23.2% of the patients did not remain on potentially inappropriate drugs after PEG surgery because they received a modified medication list. Conclusions: The majority of patients were on inappropriate drugs after PEG. This demonstrates a problem that should be addressed within Region Gävleborg. The fact that a large proportion of patients were identified as being on inappropriate medication after PEG indicates the need for pharmacist reviews of medication as well as educational efforts for health care staff in the Region.

Abstract [en] Title: Discrepancies in medication lists at hospital wards identified by medication reconciliation Authors: Anderberg M. Institute: Uppsala University, Uppsala, Sweden Background and objective: An accurate medication list is essential for a correct assessment of a patient´s condition at hospitals. Previous studies have shown that patients in emergency departments often are affected by discrepancies in medication lists at hospital admission. Less research has been done regarding discrepancies after transferring patients to medical wards. The aim of this study was to identify discrepancies in the electronic medical record in hospital wards for patients admitted via the emergency department. Design: Observational study. Medication reconciliation was performed by a pharmacist shortly after the arrival of patients from the emergency department. This included a patient interview and the investigation of the patient’s medical record. The discrepancies identified at the wards were classified as either omitted drug, wrong dose, additional drug, incorrect frequency or duplicate therapy. Descriptive statistics were used and the proportion of medication lists with at least one discrepancy was presented with 95 % confidence interval. Setting: Three medical wards at Capio S:t Görans Hospital in Stockholm.  Main outcome measures: The proportion of medication lists with at least one discrepancy. The mean value of discrepancies among all patients. Classification and categorization of discrepancies regarding type and ATC index.  Results: In total, 63 patients were included with a mean age of 63 years. At least one discrepancy was identified in 43 % (95 % CI 31-55) of the medication lists. 52 discrepancies were found in total generating a mean value of 0,83 ± 1,17 discrepancies per medication list. The two most common categories were Omitted drug(33%) and Wrong dose(33%). The most frequent drug class associated with medication discrepancies was Drugs for obstructive airway diseases.  Conclusion: 43 % of the patients had at least one discrepancy in the medication list. This indicates the importance of medication reconciliations at medical wards even though the medication list has been updated at the emergency department.