Pharmacists Can Have Impact After Surgery

A new study by researchers from the Toronto General Hospital (TGH), University Health Network (UHN) and the Leslie Dan Faculty of Pharmacy has shown that including pharmacists as part of multidisciplinary teams in surgical pre-admission clinics can result in a 50 per cent decrease in medication discrepancies for patients after surgery.

The study, published in the Archives of Internal Medicine May 28, is the first randomized controlled trial to evaluate the effectiveness of a pharmacist intervention in a pre-admission clinic. Previous studies have shown that from the moment a patient is admitted to hospital to when they are discharged, there are several vulnerable moments for medication information discrepancies, which can escalate into medication errors and adverse drug events.”Discrepancies are often caused by the difficulties faced by healthcare providers in ascertaining an accurate picture of patients’ home medications,” said study lead Olavo Fernandes, pharmacy clinical site leader at Toronto General Hospital and an assistant professor at the Leslie Dan Faculty of Pharmacy. “We looked at reducing the number of discrepancies by changing the existing practice model and developing a tool to enhance the transfer of medication information.”Upon admission, patients typically meet with a nurse who, as part of a larger evaluation, performs a primary medication assessment and forwards the information to the surgeon. “We strategically designed an intervention that saw a pharmacist join the assessment and focus on a more detailed medication information assessment,” said Professor Jana Bajcar of pharmacy, one of the study’s authors. “Our goal was to strengthen the collaborative environment while increasing patient safety.”In the intervention group (where the pharmacist performed the medication assessment) 20 per cent of 202 patients had at least one medication discrepancy related to home medications, compared with 40 per cent of 214 patients in the standard care group. Moreover, in the intervention group, nearly 13 per cent of patients had at least one postoperative medication discrepancy with potential to cause harm, compared with nearly 30 per cent in the standard care group. The team also designed a postoperative medication order form to support surgeon prescribing of home medications.”The form was created to facilitate a continuity of care for patients as they transition from home to hospital admission,” Fernandes said.”By proactively generating medication orders to support surgeon prescribing through the use of the medication order form, the need for reactive and time-consuming order reconciliation after hospital admission is minimized,” added Yvonne Kwan, a clinical pharmacist at TGH and U of T alumna who also contributed to the study.A training program for pharmacists joining the assessment process was alsodeveloped by the team. The study has already effected change at UHN; surgical preadmission clinics at TGH and Toronto Western Hospital are looking to incorporate pharmacists by the fall of 2007.(Source: Archives of Internal Medicine : Maria Saros Leung : University of Toronto : July 2007)