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

Neetu Bansal, Wan-Tien Tai, Li-Chia Chen

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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.
Original languageUndefined
JournalJournal of clinical pharmacy and therapeutics
Early online date9 Sept 2019
DOIs
Publication statusPublished - 2019

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