PHARMACIST’S BEST POSSIBLE MEDICATION HISTORY COLLECTION AS A PRE-ADMISSION CLINICAL PHARMACY SERVICE FOR SELECTED SURGERY PATIENTS
European Statement
Clinical Pharmacy Services
Author(s)
Laura Camuffo (1), Daniele Mengato (1), Monica Bettio (1), Francesca Venturini (1)
1) Hospital Pharmacy Department, Padua University Hospital
Why was it done?
A pre-admission clinical pharmacy service for best possible medication history (BPMH) collection was developed and implemented at an Italian university hospital for selected surgery patients.
What was done?
In the surgery setting, studies have shown that pre-admission medication histories are more accurate when collected by pharmacists compared to other usual standards of care [1]. At Padua University Hospital, promising results were obtained performing an observational study in which pharmacist-led BPMHs were collected for patients admitted to the pre-admission outpatient clinic of a General Surgery Department [2]; a pre-admission clinical pharmacy service, however, had yet to be implemented and officially recognized.
How was it done?
The following steps were considered for service implementation: 1) Patient’s selection: patients undergoing major elective surgery, with polytherapy (5 or more concomitant drug) or taking relevant perioperative medications (eg. anticoagulants, antiplatelets) were selected as target patients; 2) Standardization of BPMH collection: a standardized interview with the patient (or caregiver) was carried out in order to collect BPMHs; all pharmacists involved underwent specific training; 3) Definition of setting and timing for BPMH collection: the interview was conducted by phone call a few days before patient’s surgical pre-admission visits; 3) Reporting of BPMH: all collected BPMHs were directly inserted by the pharmacists in the patient’s electronic health record (EHR).
What has been achieved?
In January 2023 the pre-admission clinical pharmacy service was implemented for three main surgery departments. During 2023, 772 patients undergoing major elective surgery were interviewed and a total of 791 pre-admission BPMHs were collected. Patients’ median age was 72 years old (IQR: 65, 80) and median number of concomitant medications was 7 (IQR: 4, 10). 230 patients (29.08%) underwent general surgery, 478 (60.43%) underwent urologic surgery, 77 patients (9.73%) underwent orthopedic surgery and 6 (0.76%) underwent another type of major surgery. All BPMHs were inserted by the pharmacists in the patient’s EHRs.
What next?
The next objectives of the service will be to offer a complete patient’s pre-admission pharmaceutical assessment, also conducting, in addition to BPMH collection: pre-admission medication reconciliation, drug discontinuation, bridging, replacement and deprescribing [3].