Development and validation of a guide for the continuity of care in perioperative medication management

BACKGROUND: Increased longevity and the prevalence of associated pathologies is leading to more hospital admissions involving chronic patients with multiple pathological problems. In orthopedic surgical patients, it is very important to individually evaluate the risk/benefit of maintaining or suppressing chronic medications. For certain medications, there are consensus recommendations, but for others, the available information may be limited or controversial. OBJECTIVE: To develop and validate a new guide for the continuity of care in perioperative medication management in older orthopedic surgical patients. MATERIALS AND METHODS: An expert pharmacist developed the guide by systematically reviewing each medication category according to the Anatomical Therapeutic Chemical (ATC) classification system. The Pharmacy and Therapeutics Committee at the Hospital General Universitario de Elche reviewed the guide. After a training course on the guide for pharmacists, the guide was validated by studying the interobserver variability between pharmacists as well as between each pharmacist and the expert pharmacist. Cohen’s kappa index (κ) was applied to determine interrater reliability. RESULTS: The guide includes 51 therapeutic groups. Each ATC pharmacological subgroup is structured according to the benefits and risks of continuing therapy. When we compared each pharmacist’s recommendations with those of the expert pharmacist, the kappa value was found to be 0.8 [95% CI (0.7, 0.9)], indicating almost perfect concordance (overall percentage agreement 89.3%). CONCLUSIONS: We developed a guide for the continuity of care in perioperative medication management to improve the rationalization of medicines in the perioperative environment. After the pharmacists had been trained, the guide was validated by demonstrating a high level of concordance among the pharmacists’ recommendations. Formal training seems to be essential to ensure consistency in medical decisions. LEVEL OF EVIDENCE: IV (Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653).