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Abstract

Background:

The medication lists in pre-admission clinic (PAC) questionnaires completed by patients prior to surgery are often inaccurate, potentially leading to medication errors during hospitalization. Studies have shown pharmacists are more accurate when obtaining a medication history and transcribing prescription orders, thereby reducing errors.

Objective:

To evaluate the impact of a PeRiopErative and Prescribing (PREP) pharmacist on postoperative medication management.

Methods:

A randomized prospective interventional study enrolled elective surgery patients at high risk for medication misadventure to receive PREP pharmacy service or usual care (control group). A best possible medication history (BPMH) was obtained by the PREP pharmacist and was available to surgical staff on admission. The PREP pharmacist also prepared discharge prescriptions for their patients. The primary outcomes for the study were accuracy of BPMH and discharge prescriptions compared to usual care. The study was powered to 80% with 2-tailed significance α of .05.

Results:

The medication history in the PREP pharmacist group had fewer errors than the control group: 9% (5/53) versus 96% (49/51; P < .001). Discharge prescriptions prepared by the PREP pharmacist had fewer errors than control group: 25% versus 78% (P < .001). Significantly, more PREP pharmacist patients received a discharge summary with a complete medication list: 75% versus 33% (P = .001). Inpatient prescribing was more accurate in the PREP pharmacist patients: 0.64 versus 1.31 errors per patient (P = .047).

Conclusion:

Inclusion of the PREP pharmacist role in the elective surgery multidisciplinary team improved the accuracy of medication histories, inpatient prescribing, and discharge prescriptions for patients at high risk of medication misadventure.

Keywords

surgery pharmacy

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References

Marotti

Kerridge

Grimer

. A randomised controlled trial of pharmacist medication histories and supplementary prescribing on medication errors in postoperative medications. Anaesth Intensive Care. 2011;39(6):1064–1070.

Hale

Coombes

Stokes

, et al. Perioperative medication management: expanding the role of the preadmission clinic pharmacist in a single centre, randomised controlled trial of collaborative prescribing. BMJ Open. 2013;3(7):1–10.

Kwan

Fernandes

Nagge

, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;167(10):1034–1040.

Brunswicker

Yogarajah

. Improving pre-operative medicines reconciliation. BMJ Qual Improv Rep. 2014;3(1):1–3.

Grimes

Deasy

Allen

, et al. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Qual Saf. 2014;23(7):574–583.

Mekonnen

McLachlan

Brien

. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(2):128–144.

Dooley

Van de Vreede

Tan

. Patient-completed medication histories versus those obtained by a pharmacist in a pre-admission clinic. J Pharm Pract Res. 2008;38(3):216–218.

Australian and New Zealand College of Anaesthetist [Internet]. Melbourne (VIC): Guidelines on Pre-Anaesthesia Consultation and Patient Preparation; 2017. http://www.anzca.edu.au/documents/ps07-2008-recommendations-for-the-pre-anaesthesia.pdf. Updated September 2017. Accessed May 2018.

deClifford

Lam

Leung

. Evaluation of a pharmacist-initiated e-prescription transcription service for discharged patients. J Pharm Pract Res. 2009;39(1):39–42.

10.

Banakh

. Experience and outcomes of a junior pharmacist in a prescribing role. Poster presented at Medicines Management 2009. In: The 35th SHPA National Conference; November 5-8, 2009; Perth, Australia.

11.

deClifford

Lam

Leung

. Implementation and acceptance of a Pharmacist-initiated E-script Transcription Service for discharge prescriptions. J Pharm Pract Res. 2009;39(4):286–289.

12.

Urbaniak

Plous

. Research Randomizer (Version 4.0) [Computer software]; 2013. http://www.randomizer.org/. Accessed February 10, 2016.

13.

Gnjidic

Hilmer

Blyth

, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–995.

14.

Hubbard

Peel

Scott

, et al. Polypharmacy among inpatients aged 70 years or older in Australia. Med J Aust. 2015;202:373–377.

15.

Stawicki

Gerlach

. Polypharmacy and medication errors: stop, listen, look, and analyze. OPUS 12 Scientist. 2009;12:6–10.

16.

Kennedy

van Rij

Spears

, et al. Polypharmacy in a general surgical unit and consequences of drug withdrawal. Br J Clin Pharmacol. 2000;49(4):353–362.

17.

Society of Hospital Pharmacists of Australia. SHPA standards of practice for clinical pharmacy. J Pharm Pract Res. 2013;43(2):S42–46.

18.

Gleason

Groszek

Sullivan

, et al. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;61(16):1689–1695.

19.

Cornish

Knowles

Marchesano

, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424–429.

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