Surgical Pre Admission
Review Clinics (SPARC)
Truc Nguyen
Pharmacy 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
Objectives
• 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
Methodology
Phase One: Control phase
Initial patient flow
Nurse
•
•
•
•
Dr
Pharmacist
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
Methodology
Phase One: Control phase (110 patients)
Initial patient flow
Nurse
Dr
Pharmacist
Phase 2: Intervention phase (140 patients)
Nurse
Dr
Nurse
Pharmacist
Pharmacist
Dr
Results - Safety
Phase 1
Nurse
Dr
Pharmacist
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
• Phase 1 = 110 patients
Discrepancies
(Drug charting errors)
• 0.8 discrepancies per patient
– Wrong medication
- Wrong strength
– Wrong frequency
- Wrong route
– Inappropriate pre/post-operative prescribing
Dis: 89/110
Phase 1 = 110 patients
Calculating cost of
interventions
• 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)
What did the pharmacist do??
(2nd phase)
• 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
Times taken at Pre-admission
clinics
Time taken with Pharmacist at Pre-Admission clinics
45
40
40
35
Time taken (minutes)
35
30
30
25
20
20
Phase One
=110 pts
Phase Two
=140 pts
14
15
10
10
5
0
Total Time
Doctor
Pharmacist
Phase 1
Nurse
Dr
P<0.05
Phase 2
Pharmacist
Nurse
Pharmacist
Dr
Time
• 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…..
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 preadmission clinics”
Feedback
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)
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!
What was the cost?
• 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
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 perioperative chest infection and intra-operative
respiratory problems
• Referred to anaesthetic -> Respiratory review
• End result -> family discussion