Clinical Pharmacist Service Associated With Improved Outcomes and Cost Savings in Total Joint Arthroplasty

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…As pharmacotherapy experts with a longitudinal view of the perioperative care continuum, pharmacists are well-poised to perform or oversee many important functions to optimize surgical patient analgesia and institutional opioid stewardship efforts [ 27 , 478 , 527 ]. These may include completing pre-admission medication reconciliation, advising on preoperative optimization and planning for perioperative management of chronic pain therapies, developing standardized preemptive analgesic protocols with appropriate patient-specific adjustments, supporting intraoperative multimodal analgesic use through protocol development, education, and operationalization, managing postoperative analgesic therapies, advising on discharge opioid and nonopioid prescribing, developing patient educational materials and providing discharge counseling, and assessing patients at follow-up to optimize opioid tapers and screen for postoperative complications [ 68 , 478 , 528 , 529 ]. One pre- and post-intervention study spanning 6 years evaluated the impact of a pharmacy-directed pain management service that performed both consult-based and stewardship functions at a large public hospital.…”

“…A comprehensive clinical pharmacy service in a total joint arthroplasty population at another institution included preoperative education, postoperative pain management optimization, and discharge counseling interventions. This service was associated with improved patient understanding of discharge medications and patients indicated a high degree of satisfaction with pharmacist interactions [ 529 ].…”

Impact of clinical pharmacist services on anticoagulation management of total joint arthroplasty: A retrospective observational study

“…9,10 The implementation of a comprehensive clinical pharmacy service, from an institution providing TJA procedures in the United States, was associated with improved institutional rates of postoperative readmissions and complications, patient understanding and satisfaction. 11 Current prescribing practices for VTE prophylaxis are suboptimal, particularly regarding the use of appropriate prophylaxis in accordance with evidence-based guidelines. The Chinese state has set up a series of quality improvement programme such as hospital review criteria, medical quality management and control indicators, management of surgical complications, improving adherence with best practice recommendations and ultimately reducing the risk of VTE.…”

“…Although several studies have explored pharmacist-led anticoagulation service, to our knowledge, limited evidence had comprehensively evaluated its impact on the relevant indicators of anticoagulation management in patients with TJA. 7,11,12 The aim of this study was to evaluate the impact of clinical pharmacist intervention on the administration of anticoagulant drugs, the rationality of the medication and the incidence of thromboembolic events.…”

The role of hospital pharmacists in clinical practice of hospital pharmaceutical care: a review

“…Studies related to nursing in intensive care unit have shown that the addition of pharmacists can optimize the treatment plan and reduce the unnecessary use of drugs, therefore, making it effective in reducing the cost of medication: Pharmacists can reduce the improper use of albumin in the intensive care unit, decrease the amount and cost of albumin, and save about $355000 a year in ICU [42]; And a study, evaluating the intervention of pharmacists in adult intensive care units, also showed that pharmacists participating in a multidisciplinary ICU team, could provide meaningful intervention advice to the medical team and reduce drug costs, saving the team about $263000 in one year [43]. Surgery or chronic diseases also cost a lot of medical expenses, and studies have shown that pharmacists can also use professional knowledge and skills to reduce the financial burden of patients: Allowing pharmacists to care for (TJA) patients undergoing total joint replacement optimizes drug treatment throughout the nursing process, which can save the institution a net cost of about $73000 per year [44]; A systematic review of the effects of pharmacists on nursing care for the prognosis of diabetes shows that such interventions can save about $80,000 per person per year compared with routine care. Thus, the study strongly recommends that experienced pharmacists should be involved in the work of multidisciplinary diabetes care teams on a long-term basis [45].…”