Anrys PaulineGillard NathalieQuinet, FlorenceFlorenceQuinet2025-05-142025-05-142025-05-142022https://hdl.handle.net/2078.2/29185Background: Hospital admission is a transition of medical care at high risk of medication errors associated with incomplete medication history. The involvement of pharmacy technicians in obtaining the best possible medication history (BPMH) is a strategy to ensure continuity of care between home and hospital. Objectives: The objectives of this study are: - To assess the accuracy of BPMH encoding by pharmacy technicians, - To assess the clinical impact of discrepancies identified between the pharmacy technicians and pharmacist’s BPMH. Method: A 4-week prospective observational study is conducted in the surgical units of a Belgian regional hospital. In pre-hospitalization, pharmacy technicians carry out medication histories of patients hospitalized for elective surgery. They encode the BPMH in the electronic computerized prescribing order entry after a phone call to the patient or based on the patient's medical record. The BPMH identified by pharmacy technicians is compared to the BMPH obtained by a pharmacist at patient's admission. The discrepancies are classified by type and ATC class. The clinical relevance of discrepancies is assessed by a pharmacist and a physician by determining the clinical impact and likelihood of occurrence. Results: Hundred patients are included. The proportion of drugs encoded without discrepancy by pharmacy technicians compared to all drugs collected by pharmacist is 78,9%. Sixty-three patients have at least one discrepancy. A total of 121 discrepancies are observed, 70 of which concerned non-prescription drugs. Omission is the most frequent discrepancy (74,4%). Ninety-five discrepancies (78,5%) are of low risk for the patient. Nineteen discrepancies (15,7%) are rated as high risk and extreme risk, including omission of antithrombotic agent and insulin, or wrong dosage of tramadol. Conclusion: Pharmacy technicians can play a role to perform medication histories to reduce the risk of medication errors on admission. As the number of discrepancies identified in this study is high, it is essential to provide continuous training of pharmacy technicians. This should include upgrading the knowledge in pharmacology and skills for obtaining accurate drug histories.Schéma de médicationAnamnèse médicamenteuseAssistant pharmaceutico-techniquetext::thesis::master thesisthesis:36102