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IMPLEMENTING A NEW PHARMACEUTICAL CARE PROCESS IN SURGERY (submitted in 2019)
European Statement
Clinical Pharmacy Services
Author(s)
Sarah POGGIO, Anne-Sylvie DUMENIL, Sandrine ROY, Claire HENRY
Why was it done?
BPMH on admission has been performed in these departments since 2011. An analysis of the process and prescriber use of BPMH highlighted an underutilisation; average consultation rate was 29.8%. The main reasons were the online publishing interval of the BMPH and competition with the AC report which also displays medication. A previous study showed a 70% rate of patients with unintended differences between BMPH and the AC report.
What was done?
We redesigned the pharmaceutical care process for programmed patient circuits in orthopaedic and visceral surgery by providing the “best possible medication history” (BPMH) in the patient’s electronical medical record (EMR) before anaesthesia consultation (AC).
How was it done?
Due to a lack of coordination, we exchanged using surgery with anaesthesia schedules to select patients, thus improving prioritisation. We created support documents for students, describing how to conduct a phone interview in order to reassure unfamiliar patients, to gather useful data (GP, pharmacy, prescription) to produce a BPMH, to visit inpatients when admitted to confirm the BPMH’s accuracy and to assess patient satisfaction with the process. We trained 6 students and presented our work at an anaesthetist staff meeting.
What has been achieved?
Among 195 patients included from June to October 2019, 70.2% BPMH before admission were successfully published online (137/195), 67 went through the complete care path (from home to discharging), 12 never came for AC and/or surgery, 58 were published but waiting for patient’s admission and 58 failed. The reasons we failed to publish on time included inability to reach patients (31.6%), lack of sources (21.1%), time shortage before AC (17.6%), surgery cancellation (14.0%) and refusal (7.3%). 1.58 (±0.85) calls were needed to reach a patient, 13 BPMH required modification after admission (19%), and patient satisfaction on average was 5.11/6 when asked whether the call, the medication management during hospitalisation and the confirmation interview went well. Finally, the consultation rate of BMPH evolved from 29.8% in 2017 to 72% since we changed practices.
What next?
Implementing this new process in the care path streamlines information transfer between the different stakeholders (anaesthetists, surgeons, pharmacists) and provides a better integration of pharmaceutical care in surgery wards as an efficient support system for prescribers.