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Background Discrepancies between the usual medications of patients and the medications prescribed when patients are admitted to hospital could be associated with severe complications. Implementation of medication reconciliation at admission has been reported as a way to improve quality of care. Purpose The aim of the study was to evaluate the feasibility and additional contribution of a retroactive medication reconciliation process at admission in an acute cardiology unit. Material and methods Before any intervention, we included prospectively, in the first part of the study, 67 patients (mean age 64 years; 66% men). From the patient and/or family, retail pharmacist, doctor interviews, a senior and a pre-graduated pharmacist carefully collected the usual medications taken by the patient. These medications were compared with the actual medications prescribed during the hospital stay. The discrepancies were classified as justified or unjustified. In the second part of the study, the physicians in the unit were educated on the medication reconciliation process. In addition, a pre-graduated pharmacist was in charge during this period to check and discuss with the physician any medication discrepancies. The clinical impact of this intervention was evaluated prospectively on another population of 141 patients (mean age 68 years; 64% men). Results Medication reconciliation was feasible in all patients included in the study. The rate of medication discrepancies decreased dramatically from 33% in the first phase of the study to 14% after the educational intervention (p = 0.003). In addition, during the second phase of the study, the pharmacist informed the physician of any medication discrepancies. Among the 20 patients with a medication discrepancy, thanks to the pharmacist the prescription was appropriately corrected in 16 (80%) patients. Conclusion This study showed the feasibility of the medication reconciliation process in an acute cardiology unit. The rate of prescription errors was dramatically decreased after implementation of the process. Implementation of a medication reconciliation process could enhance quality of care. References and/or Acknowledgements World Health Organization. MEDREC Assuring medication accuracy at transitions in care: medication reconciliation. High 5s: action on patient safety getting started kit. 2010 No conflict of interest.

Background In less than 10 years, 2 antiaggregants and 4 direct oral anticoagulants (DOAC) were released in Europe, making antithrombotic therapy management more complicated. We considered nurses’ needs as mandatory as they play an everyday role in patient management and education. Purpose We planned to evaluate knowledge about antithrombotic therapy among nurses in our hospital in order to provide specific additional training. Material and methods A form with a set of 71 questions on 16 themes, all related to antithrombotic drugs and their management, was prepared and distributed to nurses in the heart institute (group A) or other services of the hospital (group B). Answers were analysed by a junior pharmacist using an Excel chart. Results From June to August 2014, 49 nurses in cardiology (group A) and from November 2014 to August 2015, 170 nurses from 38 others services (35% from intensive care units and 65% from adult conventional units (group B)) completed the questionnaire. In both groups, a large majority of nurses were aware that they should deliver information to patients (A, 93.9%; B, 93.5%) and that INR allows monitoring of antivitamin K (AVK) (A, 100%; B, 90.6%). Nevertheless, the results showed a lack of knowledge. For example in group A, 18.4%, and in group B, 19.4%, did not think there was any difference between heparin calcium and low molecular weight heparin; 44.9% (group A) and 51.2% (group B) did not identify acenocoumarol as an AVK. 87.7% (group A) and 85.8% (group B) ignored the fact that monitoring platelets is mandatory when using unfractionated heparin (UFH). Only 44.9% (group A) and 31.2% (group B) mentioned anti-Xa in UFH monitoring. DOAC were better identified (69.4%), and their related bleeding risk better known (73.5%) among nurses in group A than among nurses in group B (38.8% and 55.3%, respectively). Conclusion These results indicate a need for providing practical basic training on antithrombotics in our hospital. Furthermore, professional development should be encouraged to maintain and update knowledge which is essential in order to ensure safe and appropriate care. We have already scheduled a 1 day seminar in February 2016 in which training will be provided interactively with clinical cases and exchanges between caregivers and trainers. References and/or Acknowledgements Rapport ANSM Avril 2014 No conflict of interest.