Clinical, Economic, and Organizational Impact of the Clinical Pharmacist in an Orthopedic and Trauma Surgery Department

Abstract

The aim of this study was to evaluate the clinical, economic, and organizational impact of clinical pharmacist services added to an adult orthopedic and trauma surgery unit in a university hospital.Methods: This was a prospective, observational study performed from January to February 2017. All pharmacists' interventions were documented, and their clinical, economic, and organizational impact and the probability of adverse drug events (ADEs) were assessed using the clinical, economic and organizational scale three-dimensional scale. An expert panel composed of three clinical pharmacists, one surgeon and one anesthetist classified the pharmacist intervention. The potential clinical impact was determined through a consensus by the expert panel. Cost avoidance was calculated for serious ADEs with a major impact by avoiding an additional cost of €4912 per event and taking into account the probability of ADE occurrence. Results:The pharmacists performed 1014 interventions for 28 days with a 95.3% acceptance rate by prescribers. Thirty-nine interventions were rated to have a major clinical impact (3.8%). The organizational impact was estimated favorable for 856 (84.4%) pharmacist interventions. Cost avoidance was estimated at €24,364, and the indirect costs benefit was estimated at €11,864 during the study. The cost-benefit ratio of the clinical pharmacist intervention was €1.94 in savings for every €1 invested.Conclusions: Clinical pharmacist services in an orthopedic and trauma surgery department have the potential to improve patient outcomes and avoid healthcare costs. Furthermore, the presence of a pharmacist in surgical units allows for communication between the unit and the pharmacy, which produces better fluidity and improves the quality of care.

Collaboration between cardiologist and clinical pharmacist on prescription quality: What is the potential clinical impact for cardiology patients?

“…In the future, it would be interesting to set up a randomised controlled study versus control population to demonstrate the extent of contribution of the clinical pharmacist to criteria such as readmission. The economic evaluation of these optimisations will also be important data, the costs being reduced with this organisation, as suggested by Renaudin et al in the Orthopaedic and Trauma Surgery Department of our institution 23 . To confirm this trend and overcome the limitations of this study, it would be appropriate to replicate a similar experience at several centres.…”

Impact of pharmaceutical care in the orthopaedic department

“…Pharmacist interventions (PIs) are regarded as a key strategy for reducing medication errors and ADEs . Despite many studies describing the role of PIs, few have investigated their effectiveness for orthopaedic inpatients.…”

“…According to this evidence, PIs play an important role in managing antibiotic, analgesics and anticoagulants, which reduce not only medication errors and overuse but also costs. Nonetheless, past studies have reported mixed results on the effectiveness of PIs in improving prescribing practice and cost‐effectiveness for inpatients . For instance, one prospective observational study on the cost‐effectiveness of PIs showed that for every euro spent on a pharmacist's salary, 1.94 euros could be saved on medication .…”

“…Nonetheless, past studies have reported mixed results on the effectiveness of PIs in improving prescribing practice and cost‐effectiveness for inpatients . For instance, one prospective observational study on the cost‐effectiveness of PIs showed that for every euro spent on a pharmacist's salary, 1.94 euros could be saved on medication . In contrast, a comparative prospective study in Denmark reported that the reduction in medicine costs could not cover the total cost of clinical pharmacy services .…”

“…A medication review can be defined as a systematic assessment of an individual patient's medications that in agreement with the patient, aims to evaluate and optimize the drugs' effectiveness, minimize drug‐related problems and reduce waste . Such assessments range from prescription to full clinical medication reviews, and medical treatment is evaluated in the context of a patient's conditions and symptoms.…”