Implementation of an innovative surgical pharmacy service to improve patient outcomes—Twelve‐month outcomes of the Enhanced Surgical Medicines Optimization Service

Abstract

What is known and objective: Pharmacists play vital roles in medicines optimization in different care settings. Studies have shown that optimizing patient's pre-existing co-morbidities prior to the surgery leads to better post-operative outcomes. The Enhanced Surgical medicines optimization service (ESMOS) is an innovative surgical pharmacy service introduced at a large teaching hospital in the UK in September 2017 which aimed to reduce the length of stay and post-operative complications in general surgical patients. This purpose of this study is to evaluate the implementation and outcomes of this service at 12 months after it was rolled out. Methods: This cohort study was undertaken between September 2017 and September 2018. Adult patients undergoing elective major general surgical procedures were included and stratified into four sub-specialties, including hepato-pancreato-biliary (HPB), upper gastrointestinal (GI), lower GI and vascular surgery. Patients undergoing emergency and day case procedures or with missing outcome data were excluded from this study. Patients' demographics, baseline co-morbidities, high-risk medications, American Society of Anaesthesiologists (ASA) physical status classification, surgical procedure, post-operative complications, length of stay and nature of pharmacist interventions were collected and reported by descriptive statistics. Length of stay was compared with the corresponding expected length of stay by the national standard. Results and discussion:A total of 246 patients were included in the four general sub-specialties: HPB (n = 82), upper GI (n = 17), lower GI (n = 87) and vascular (n = 60).There was a significant reduction in the median length of stay in three surgical specialties, compared with the national standard: lower GI (median reduction: −2; IQR: −4, 1.8; P = .038), HPB (median reduction: −4.5; IQR: −7, −1; P = .001) and vascular (median reduction: −2; IQR: −4, 0; P = .043). What is new and conclusion:The ESMOS model is a novel care pathway that allows both early identification of medicines optimization and peri-operative drug management issues in surgical patients, and potentially reduces the overall length of stay. K E Y W O R D Selective surgery, length of stay, medicines optimization, pharmacist-led, post-operative complications

Pharmacist‐driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery

“…35 The involvement of pharmacists may be promising to improve patient outcomes and speed up patient recovery after surgery. 27,28 In this study, we demonstrated that the CPGT effectively improved PONV for pa- 36 feedback, 36 educational outreach 24,37 and dedicated support. 24 Another strength was the enrolment of a series of patient-related outcomes.…”

“…25 A multidisciplinary clinical pharmacist-led guidance team (CPGT) has gradually been proven as a promising service mode to enhance healthcare quality in previous studies conducted in the First Affiliated Hospital of Zhejiang University (FAHZJ) 19,25,26 and other settings. 27,28 Through active intervention, the CPGT in the FAHZJ has achieved several improvements, such as increasing the rationality of using prophylactic antibiotics in intervention procedures, 26 enhancing the efficacy of cancer pain therapy, and improving postoperative pain of transarterial chemoembolization in patients with hepatocellular carcinoma. 29 In 2015, the enhanced recovery pathway was introduced in the FAHZJ to improve outcomes for surgical patients.…”

Assessing the Impact of a Clinical Pharmacist in a Postsurgical Inpatient Population

“…19 Bansal et al showed a reduction in hospital length of stay compared to the national average in patients undergoing elective major general surgery when pharmacists were involved in perioperative patient care. 20…”

Standard of practice in surgery and perioperative medicine for pharmacy services

“…withholding versus continuing regular medicines), venous‐thromboembolism (VTE) and surgical antimicrobial prophylaxis 9,13,14,16–21 providing guidance on optimising medicines and/or conditions (e.g. smoking cessation, blood glucose levels and diabetes) 9,22–24 supporting stewardship of high‐risk medicines (e.g. opioids, anticoagulants, antimicrobials) 25–30 ensuring quality improvement and cost‐effective care 17,31–34 applying principles of medication safety (e.g.…”