[The medication history: a tool to optimize the preoperative anesthesia consultation?]

Since 2011, medication histories (MH) are performed at patient's admission in orthopaedic and visceral surgery wards, 40% patients have their surgery planned. During the anaesthesia's consultation, the anaesthetist reported usual treatments on a consultation report (CRI) which is also the preoperative prescription. The objective of this study was to evaluate if MH done prior to anaesthesia's consultation improve treatments report on the CR. A comparative prospective study was conducted over 3 months, including all patients for planned surgery. In the intervention group (I/G), a first MH was performed before the anaesthesia's consultation. When MH was not completed before the anaesthesia's consultation, patients were included in the control group (CG). For every patient, a MH was carried out at admission. Discrepancies between MH at patient's admission and CR, the clinical impact of these discrepancies and the sources used to write the MH were evaluated. 91 patients were included. Discrepancies were found in 56% of the JG and 42% in the CG (p=0.56). Main discrepancies were: missing drug on CR (25% vs. 22%; p=0.71). missing dose (21% vs. 25%; p=0.13) and missing dosage (8% vs. 18%; p=0.06). In the JG, discrepancies with potential significant severity were reduced by half (7% vs. 15%; p=0.26). 2±0.9 sources (average) were consulted to write the MH in the IG and 2.8±0.9 in the CG [p<0.05l. The MH availability before the anaesthesia's consultation does not seem to reduce discrepancies in the CR. This may be explained by the way the MH was elaborated in the CG, using the CR used as source in 75%. However, MH provides more reliable inforrr:tation on treatments for the anaesthetist than previously with a reduction of discrepancies with potential significant severity. However, the medication conciliation at admission process should be re-engineered and CR not considered anymore as a relevant source. In any case, MH has to be updated at patient's admission in order to take account of any undercurrent treatment's modification.