The impact of the pharmacist on an elective general surgery pre‐admission clinic
- 299 Downloads
Objective: A traditional clinical pharmacy service for surgical patients involves a ward visit that identifies and responds to issues after prescribing has taken place. It was hypothesised that pharmacist involvement in a general surgery pre‐admission clinic (PAC) would provide elective patients with significantly better pharmaceutical care than ward visits alone.Method: 100 elective general surgery patients were recruited into 2 groups as part of a non‐randomised controlled trial. The groups were comparable in terms of age, surgical procedure and use of medicines. The control group received standard ward visits. The intervention group had pharmaceutical assessment in a pre‐admission clinic. This assessment incorporated pharmacist‐led drug history taking and prescription transcription.Outcome measures: Number, classification and clinical significance of pharmaceutical interventions.Results: A pharmacist made 76 interventions in the PAC group and 79 interventions in the ward group. No prescribing errors and omissions were made in the PAC group. The clinical significance of PAC interventions was rated more highly than ward interventions on two scales. Involvement in the PAC increased the pharmacist's workload, but saved time for surgical and nursing staff. Surgical and nursing staff identified writing discharge prescriptions as the most valuable service provided by the PAC pharmacist.Conclusion: By ensuring safe prescribing in the PAC group, the pharmacist was able to become more involved in clinical issues. Pharmacist involvement in PACs presents a useful opportunity for expansion of pharmacy services. However, extra resources would be needed in order to provide these services fully.
Unable to display preview. Download preview PDF.
- 1.Cousins DH, Luscombe DK. A new model for hospital pharmacy practice. Pharmaceutical Journal 1996;256:347-51.Google Scholar
- 2.Bhanji AA, Fallon KM et al. Pharmacy involvement in a surgery pre-admission program. Am J Hosp Pharm. 1993;50:483-6.Google Scholar
- 3.Wall M, Radley A. The potential of pre-admission clinics to improve the pharmaceutical care of elective surgery patients. United Kingdom Clinical Pharmacy Association (UKCPA) Progress In Practice Residential Symposium Autumn 1996.Google Scholar
- 4.Hall I, Craine J and Cattell R. Improving pharmaceutical care for elective surgical patients. Oral presentation given at Guild of Healthcare Pharmacists National Weekend School April 1999.Google Scholar
- 5.Smith H. Pharmacist involvement in a surgical pre-admission clinic improves the quality of patient care. Pharma 1997;259:902.Google Scholar
- 6.Hebron B, Jay C. Pharmaceutical care for patients undergoing elective ENT surgery. Pharmaceutical Journal 1998;260:65-6.Google Scholar
- 7.Dean BS and Barber N. A validated, reliable method of scoring the severity of medication errors. Am J Health-Syst Pharm 1999;56:57-62. 8 Personal communication on 20.10.98 with Bryony Dean, Research Pharmacist, Centre for Pharmacy Practice, The School of Pharmacy, 29-39 Brunswick Square, London. One of the authors of reference (7).Google Scholar
- 9.Hatoum HT, Hutchinson RA et al. Evaluation of the contribution of clinical pharmacists: Inpatient care and cost reduction. Drug Intell Clin Pharm 1988;22:252-9.Google Scholar
- 10.Crown J. Review of prescribing, supply and administration of medicines (Final Report). London: Department of Health; 1999.Google Scholar
- 11.National Health Service. Pharmacy in the future – implementing the NHS Plan. London: Department of Health; 2000. 69 Volume 23 No. 2 2001 Pharmacy World & Science Table 3 Guidelines for PAC pharmacists should include: Drug history taking Patients' own drugs In-patient prescriptions Discharge medication Provision of information Documentation of interventions Discharge Planning GP LiaisonGoogle Scholar