Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs

Lovely, Jenna K.; Hyland, Sara J.; Smith, April N.; Nelson, Gregg; Ljungqvist, Olle; Parrish, Richard H.

doi:10.1016/j.ijsu.2019.01.006

Cited by 24 publications

(20 citation statements)

References 20 publications

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“…In this sense, it is important to assess risk and damage to patients in the search for ultimate patient safety. 1,2 Though Surgery is an essential component in health care, complications after surgery account significantly for morbidity and mortality; mainly related to anesthesia and surgical site infection. 3 Besides, patients admitted to the surgery ward might receive a large number of drugs both for surgery and unrelated to surgery, hence, be at risk for drug therapy problems (DTPs) and postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

<p>Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study</p>

Tefera¹,

Zewudie²,

Jima³

et al. 2020

DHPS

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Background: Drug therapy problems (DTPs) are of major concern in health care because of the associated increased cost of treatment, morbidity, and mortality. Thus, clinical practice should constitute the mainstream practice of clinical pharmacy in every ward. However, nothing is known about DTPs and the role of clinical pharmacist in the surgical ward of Ethiopia (the neglected ward). Objective: To assess the prevalence of DTP among patients hospitalized at the surgical ward and the role of clinical pharmacists in their identification and resolution. Methods: Hospital-based prospective observational and interventional study design was used with daily patients' chart review using a semi-structured questionnaire among hospitalized adult patients at the surgical ward. After identification of DTP, verbal communication was used as a means of intervention with the treating physician. Acceptance of clinical pharmacist's intervention was considered only if a change was made to the patients' medication order. To identify determinants of DTPs, multiple stepwise forward logistic regression analysis was done by SPSS version 20.0. Statistical significance was considered at p-value < 0.05. Written informed consent was sought and the data were secured. Results: The response rate was 97.1% (300) for the final analysis. The mean (±SD = standard deviation) age of the participants was 42.62 ±18.29 with male (67%) predominance. DTP was identified in 76% of study participants. A total of 449 DTPs were identified, which equates with an average of 1.97 per patient. Dose too low 124/449 (27.6%) and dose too high 81/449 (18.0%) were found to be the most common types of DTPs. The intervention rate was 86.0% (196/228 per patients) and 86.2% (387/449 DTPs), with the acceptance rate of 85.2% (167/196 per patients) and 78% (302/387 per DTP) which mean (67.3%) 302/449 of the problems were fully resolved by the clinical pharmacist. Poly-pharmacy [AOR, 7.23; 95% CI, 2.29-22.13: P-value < 0.001] and hospital stay > 20 days [AOR, 5.42; 95% CI, 2.74-10.70; p < 0.001] were the only independent predictors for DTPs. Conclusion and Recommendation: This study identified a high prevalence of DTP which was independently predicted by the presence of poly-pharmacy and >20 days of hospital stay. The rate of intervention provided and acceptance from the physician was high, which is one indicator that the role of clinical pharmacists in the identification and resolution of DTP was paramount in the surgery ward and should be implemented as a must not as optional.

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Section: Introductionmentioning

confidence: 99%

<p>Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study</p>

Tefera¹,

Zewudie²,

Jima³

et al. 2020

DHPS

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“…Another example may be when the Pharmacist may recognize that a certain amount of opioid medication was a signal for reassessment—patients requiring more than the usual needed attention. This attention can afford a new diagnosis of a complication or a reassessment in partnership with the pharmacist for another multimodal option and work to taper the opioid effectively [ 37 , 38 , 55 , 56 ].…”

Section: Methodsmentioning

confidence: 99%

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

Lovely

Larson

2021

Healthcare

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This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, Improve, Control (DMAIC) process of ongoing quality improvement and through research efforts. The information applies to all readers that provide surgical care within their organization as the fundamental principles of enhanced recovery for surgery are applicable regardless of the setting.

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“…Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. They include the following: (1) pre-anesthetic medication; (2) prophylaxis against venous thromboembolism (VTE); (3) antimicrobial prophylaxis and skin preparation; (4) standard anesthetic protocol; (5) post-operative nausea and vomiting (PONV) prophylaxis; (6) perioperative fluid management; (7) prevention of postoperative ileus (including use of postoperative laxatives); (8) postoperative analgesia, and (9) postoperative glucose control [7]. While these recommendations address global concepts of perioperative patient care, the ERAS protocols do not specify particular pharmacotherapeutic medication classes, agents, or doses.…”

Section: Research Strategymentioning

confidence: 99%

Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study

et al. 2020

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Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.

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Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs

Cited by 24 publications

References 20 publications

<p>Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study</p>

<p>Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study</p>

Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic

Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study

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