PP473 - MEDICATION RECONCILIATION AND MANAGEMENT OF INAPPROPRIATE DRUG MANIPULATION IN PATIENTS RECEIVING ENTERAL NUTRITION: CLINICAL IMPACT OF PHARMACIST-LED INTERVENTIONS

PP473

MEDICATION RECONCILIATION AND MANAGEMENT OF INAPPROPRIATE DRUG MANIPULATION IN PATIENTS RECEIVING ENTERAL NUTRITION: CLINICAL IMPACT OF PHARMACIST-LED INTERVENTIONS

B. Pantolini¹, T. Garraffa¹, M. S. Fusco¹, G. Pavanello¹, E. Dalla Fontana¹, M. E. Tirelli², M. Risicato^2,*, A. Cavioni², A. Mascheroni², R. Cursano¹

¹OUC FARMACIA OSPEDALIERA, ²UOSD Dietologia e Nutrizione Clinica, ASST MELEGNANO E MARTESANA, MILAN, Italy

Rationale: Patients requiring enteral nutrition (EN) frequently present with complex clinical conditions and extensive polypharmacy.

This study aimed to quantify the prevalence of inappropriate drug manipulation in patients over 65 years of age receiving EN and to evaluate the clinical impact of a structured, pharmacist-led medication reconciliation program in reducing high-severity risks.

Methods: A retrospective observational study was conducted on the chronic pharmacological therapies of 40 patients receiving EN. A total of 914 prescriptions were systematically reviewed. The analysis focused on identifying discrepancies between the prescribed dosage form and the route of administration, detecting major drug–drug and drug–enteral nutrition interactions, and assessing the clinical severity of each identified error.

Results: The analysis demonstrated a high level of therapeutic complexity. A total of 144 oral dosage forms were identified as being incorrectly manipulated, including 52 cases involving major pharmacological interactions. High-severity clinical risk was identified in 22 medications, affecting 16 patients (40% of the cohort). Following the clinical pharmacist’s intervention, physicians performed medication reconciliation for 15 of these patients (93.7%). This was achieved by substituting medications with therapeutic alternatives compatible with EN and through galenic preparations when commercial alternatives were unavailable.

Conclusion: Inappropriate drug manipulation represents a critical and often underrecognized safety issue in patients receiving enteral nutrition. Multidisciplinary reconciliation nearly eliminated high-severity risks, confirming that physician-pharmacist collaboration is a key strategy for optimizing patient safety and clinical outcomes in enteral nutrition.

Disclosure of Interest: None declared