Background and importance Surgical patients are at risk of medication-related adverse events, with some of these patients having comorbidities requiring long-term medications prior to surgery. Published data suggest pharmacist interventions can reduce adverse drug reactions (ADRs) and medication errors and reduce hospital length of stay.
The effect of implementing a pharmacist into the HpB surgical ward round (WR) was unknown; this would also support ongoing service development projects in liver pharmacy on patient pathways.
Aim and objectives To establish the range and clinical impact of interventions made by the specialist pharmacist when attending HpB post-surgical WR as part of ongoing pharmacy engagement and service development.
To measure the number of interventions being made by the specialist pharmacist on WR.
To determine the common themes of pharmacist interventions.
To determine the proportion of ‘on the spot’ pharmaceutical advice given to healthcare professionals and patients as part of this process.
Material and methods A prospective study of 1 month, with attendance at two WR per week. Review of all postsurgical HpB on an inpatient ward. All interventions were collated and categorised based on commonality.
Results Over the course of data collection, the pharmacist reviewed 140 patients and made 477 interventions as part of the WR. This included 45 history medications restarted, identification of 32 ADRs to current treatment, 16 instances of vancomycin dose adjustments, confirmation of anticoagulation for 17 patients and addition of 101 antibiotic stop dates contributing to better antimicrobial stewardship. There were also 70 instances of a nurse/doctor/patient requiring additional information on medication treatments.
Conclusion and relevance This study has highlighted the scale of interventions a pharmacist can make on a WR, emphasising not only adjustment of medications but also the need for medication-related information by healthcare professionals and patients alike.
Moving forward a pharmacist will attend at least two WR per week, with potential scope for support in pre-assessment and postoperative clinics to review weaning of analgesia and long-term management of pancreatic replacement, for example.
With the recent announcement regarding new standards for the initial education and training of pharmacists in the UK, it would be valuable to assess the impact of a prescribing pharmacist on these WR.
Conflict of interest No conflict of interest
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