Surgical Pre Admission
Review Clinics (SPARC)
Truc NguyenPharmacy Surgical Team Leader
CMH Pharmacy
Surgical Preadmission Clinics• Aim to improve patient safety and experience
– Identify/minimise peri-operative risks– Improve patient education– Enables patients to present to surgery fully prepared
and as fit as possible
Nurse Doctor Pharmacist
• Primary objectives:• To assess the effectiveness of clinical pharmacy service to
pre-admission clinics
– Evaluation of the number and type of discrepancies/contributions recorded by pharmacist
• Secondary objectives:– To assess the value of having a pharmacist in a
preadmission clinic
– Patient satisfaction survey
– Doctor satisfaction survey
Objectives
Methodology
Phase One: Control phase
• How accurate patients medication lists were• How accurate doctors medication histories are• Errors charted by the doctor• What the patient thinks about seeing a pharmacist• Time(s) taken
Nurse
Initial patient flow
Dr Pharmacist
Methodology
Phase One: Control phase (110 patients)
Nurse
Initial patient flow
Dr Pharmacist
Nurse Dr
PharmacistNurse Dr
Pharmacist
Phase 2: Intervention phase (140 patients)
Results - Safety
• Phase 1 = 110 patients
Phase 1 Regular meds and PRN meds
Patient and Pharmacist
2.22 discrepancies per patient
Pharmacist and Doctor
9% more regular medications
38% more PRN medications
17% more Allergies/ADR
Nurse
Phase 1
Dr Pharmacist
• 0.8 discrepancies per patient
– Wrong medication - Wrong strength
– Wrong frequency - Wrong route– Inappropriate pre/post-operative prescribing
Dis: 89/110
Discrepancies(Drug charting errors)
Phase 1 = 110 patients
• Easy done when retrospectively
• Davies et al state a moderate adverse event in hospital can increase length of stay 7-9 days.
• Average length of stay for a general surgical patient is ~3 days
• 1 day? – 50 bed days saved…
• ½ days- 594 bed days saved (1307 pts)
Calculating cost of interventions
• Medication history + review
• Pre-chart medications (including analgesics, anti-emetics) for the doctors
• Printed out electronic history form with any potential recommendation in Dr alert section
• Educated patient on start/stopping of medications, compliance etc
What did the pharmacist do??(2nd phase)
Times taken at Pre-admission clinics
Time taken with Pharmacist at Pre-Admission clinics
40
30
10
35
20
14
0
5
10
15
20
25
30
35
40
45
Total Time Doctor Pharmacist
Tim
e ta
ken
(m
inu
tes)
Phase One
Phase Two
P<0.05
=110 pts
=140 pts
Nurse
Phase 2
DrPharmacistNurse
Phase 1
Dr Pharmacist
• Saved 5 minutes per patient (waiting time)– 5min X 140 patients = 11.6 hours clinic time
• Doctors time saved 10 minutes per patient– 10 X 140 patients = 23.3 hours of doctors time
…..Then extrapolated over 1307 patients…..
Time
Doctors feedback• Adds value• Reduces workload• Improves peri-operative
plan for the patient– High risk medications
• Accurate medication history
• Allergy recording• Patient counseling
• “Reduces time spent on each patient in regards to medications allowing doctors to focus more on the medical problems of the patient in the short period of time available in pre-admission clinics”
Patients feedback•Useful person to see•Discussed regular medication•Clear directions about what medication to stop prior to surgery•Discussed any concerns about medications associated with surgery (e.g. pain relief)•Discussed what medication would be started after surgery (potentially)
Feedback
Conclusions
- Accurate medication histories
- Significant amount of errors picked up
- Improved clinic times
- Valuable service to both patient and MDT
- Future plans - Expansion of clinics to Orthopaedics??
THANK YOU!
• 0 FTE allocation to initiate surgical pharmacy pre-admission clinics
HOW??• Restructured MMH pharmacy surgical team from a
ward based service to team based.• We now have become a proactive service to that
of a reactive one• Structure creates sustainability with more than one
pharmacist doing clinics
What was the cost?
Example of Grade 4• 58Y Maori female• Staging laproscopy (Gastric cancer)• Salbutamol 15 puffs inh BD• Not known to our Respiratory service• Recently moved up from Taumaranui• Alerted doctor as patient high risk of peri-
operative chest infection and intra-operative respiratory problems
• Referred to anaesthetic -> Respiratory review• End result -> family discussion
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