Pharmaceutical care at discharge for patients with feeding tubes.

Objective: to assess and analyse a medication adaptation pathway for feeding tube administration followed by clinical pharmacists for patients at discharge, and to analyse the level of physician acceptance of the recommendations issued by pharmacists in pharmaceutical care reports to improve patient therapy. Methods: a multidisciplinary protocol for treatment adaptation to feeding tube administration at discharge was implemented in a 350-bed hospital during 2019, in which pharmacists prepared feeding tube medication-adaptation reports during pharmaceutical care visits. The number of recommendations related to adaptation of a drug to route of administration was recorded and classified as need for change of active substance or change of pharmaceutical form.

An admission medication reconciliation programme carried out by pharmacists: impact on surgeons' prescriptions.

Objectives: To describe a medication reconciliation (MR) procedure prepared by the pharmacist for patients admitted for elective surgery and to assess the surgeon's degree of acceptance.

Methods: A 1-year retrospective observational study was conducted. The patient population consisted of patients aged ≥18 years admitted during 2016 for elective surgery and whose planned length of hospital stay was >24 hours.