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Naseralallah L, Koraysh S, Aboujabal B, Alasmar M. Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis. Ther Adv Drug Saf 2024; 15:20420986241260169. [PMID: 39091467 PMCID: PMC11292727 DOI: 10.1177/20420986241260169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/20/2024] [Indexed: 08/04/2024] Open
Abstract
Background The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings. Objectives To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings. Design A systematic review and meta-analysis. Methods We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs). Results Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality. Conclusion Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.
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Affiliation(s)
- Lina Naseralallah
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
- School of Pharmacy, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham, UK
| | - Somaya Koraysh
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Bodoor Aboujabal
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - May Alasmar
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
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Xing X, Qu H, Wang L, Hao X, Zhong Y, Jing F. Enhancing Drug Management, Cost Savings, and Staff Satisfaction in Anesthesiology: A Quality Improvement Project in a Chinese Tertiary Hospital. Adv Ther 2024; 41:1953-1966. [PMID: 38494541 DOI: 10.1007/s12325-024-02814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION In alignment with China's national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists. METHODS We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023. RESULTS Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions. CONCLUSION The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings.
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Affiliation(s)
- Xiaomin Xing
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Haijun Qu
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Longyuan Wang
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Xiaojia Hao
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Yalan Zhong
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | - Fanbo Jing
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China.
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Gao S, Wang X, Lu Y, Liu Y, Jiang Q, Feng J, Kong W, Lin L, Cheng H. Current scenario and challenges of clinical pharmacists to implement pharmaceutical care in DRG/DIP payment hospitals in China: a qualitative interview study. Front Public Health 2024; 12:1339504. [PMID: 38444434 PMCID: PMC10912177 DOI: 10.3389/fpubh.2024.1339504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose The Diagnosis-Related Group (DRG) or Diagnosis-Intervention Packet (DIP) payment system, now introduced in China, intends to streamline healthcare billing practices. However, its implications for clinical pharmacists, pivotal stakeholders in the healthcare system, remain inadequately explored. This study sought to assess the perceptions, challenges, and roles of clinical pharmacists in China following the introduction of the DRG or DIP payment system. Methods Qualitative interviews were conducted among a sample of clinical pharmacists. Ten semi-structured interviews were conducted, either online or face to face. Thematic analysis was employed to identify key insights and concerns related to their professional landscape under the DRG or DIP system. Results Clinical pharmacists exhibited variable awareness levels about the DRG or DIP system. Their roles have undergone shifts, creating a balance between traditional responsibilities and new obligations dictated by the DRG or DIP system. Professional development, particularly concerning health economics and DRG-based or DIP-based patient care, was highlighted as a key need. There were calls for policy support at both healthcare and national levels and a revised, holistic performance assessment system. The demand for more resources, be it in training platforms or personnel, was a recurrent theme. Conclusion The DRG or DIP system's introduction in China poses both opportunities and challenges for clinical pharmacists. Addressing awareness gaps, offering robust policy support, ensuring adequate resource allocation, and recognizing the evolving role of pharmacists are crucial for harmoniously integrating the DRG or DIP system into the Chinese healthcare paradigm.
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Affiliation(s)
- Suyu Gao
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuanxuan Wang
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yun Lu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yunkun Liu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiaoli Jiang
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiajia Feng
- Hospital Management Institute of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Weihua Kong
- Hospital Management Institute of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Likai Lin
- Hospital Management Institute of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hong Cheng
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, China
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Sasaki Y, Kurishima A, Miyamoto C, Hataji K, Tezuka T, Katsuragawa H. Evaluation after implementation of chemical bowel preparation for surgical site infections in elective colorectal cancer surgery and role of antimicrobial stewardship pharmacist: Retrospective cohort study. J Pharm Health Care Sci 2024; 10:11. [PMID: 38374208 PMCID: PMC10875839 DOI: 10.1186/s40780-024-00333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND We evaluated the predictive factors for surgical site infections (SSIs) in elective colorectal cancer surgery and the role of antimicrobial stewardship (AS) pharmacists in modifying the clinical pathway. MAIN BODY Between February 2017 and January 2022, 414 elective colorectal cancer surgeries were performed. The results of multivariate analysis by SSI incidence were adjusted odds ratio (aOR): 0.45; 95% confidence interval (CI): 0.22-0.96 (P = 0.039) for sex (female), aOR: 0.27; 95% CI: 0.13-0.58 (P < 0.001) for laparoscopy, aOR: 0.42; 95% CI: 0.19-0.91 (P = 0.029) for chemical bowel preparation. The median (interquartile range) postoperative length of stay was 12 (10.0-18.5) vs. 10 (9.0-13.0) days before and after the clinical pathway was modified (P < 0.001). CONCLUSION The role of AS pharmacists was primarily to conduct a literature search to explore whether SSIs could be ameliorated by pharmacotherapy, coordinate the addition of chemical bowel preparation, and epidemiologically confirm their effectiveness.
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Affiliation(s)
- Yasuhiro Sasaki
- Department of Pharmacy, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan.
| | - Akira Kurishima
- Division of Public Health, Teikyo University Graduate School of Public Health, 2-11, Kaga 1-Chome, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Chieko Miyamoto
- Department of Nursing, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
| | - Kenichiro Hataji
- Department of Surgery, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
| | - Toru Tezuka
- Department of Endoscopy, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
| | - Hideo Katsuragawa
- Department of Surgery, Tama-Nambu Chiiki Hospital, Tokyo Metropolitan Organization, 1-2, Nakazawa 2-Chome, Tama, Tokyo, 206-0036, Japan
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Lu J, Chen M, He G, Chen B, Wang R. Evaluating clinical pharmacists' involvement in postoperative acute pain services: a multicenter survey in Guangdong Province, China. Front Pharmacol 2023; 14:1283071. [PMID: 37849733 PMCID: PMC10577220 DOI: 10.3389/fphar.2023.1283071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Objective: Postoperative pain management is an important part of surgical pharmacy. Postoperative acute pain services in China are in their initial stages. This survey aimed to investigate the attitudes, involvement, and knowledge of clinical pharmacists in China regarding postoperative acute pain services. The results can provide valuable information to guide clinical pharmacists in developing targeted strategies to improve their postoperative acute pain service capabilities. Methods: A questionnaire was distributed to the pharmacy departments of 133 grade A tertiary hospitals in Guangdong province, and the responses were collected electronically. Results: 123 completed questionnaires were collected from clinical pharmacists. Although 95.93% of clinical pharmacists believed they should participate in postoperative pain services, only 62.6% reported substantial involvement. Overall satisfaction with the postoperative pain service was 93.5%. Understanding of non-steroidal anti-inflammatory drugs and opioid analgesics by clinical pharmacists was comparable (p > 0.05). Furthermore, 98.37% of clinical pharmacists desired systematic learning in postoperative pain management, and 40.65% expressed a strong need. Conclusion: Clinical pharmacists in China demonstrate a positive attitude toward participating in postoperative acute pain services. However, the actual level of involvement was concerning, and the lack of systematic training and well-established work protocols may be contributing factors. Efforts should be made to establish comprehensive and standardized processes and work protocols for postoperative acute pain services and provide systematic and hierarchical professional training to enhance clinical pharmacists' capabilities in postoperative acute pain services.
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Affiliation(s)
- Junxiong Lu
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingzhen Chen
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guansheng He
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Binwei Chen
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ruolun Wang
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Mengato D, Pivato L, Codato L, Faccioli FF, Camuffo L, Giron MC, Venturini F. Best Possible Medication History Collection by Clinical Pharmacist in a Preoperative Setting: An Observational Prospective Study. PHARMACY 2023; 11:142. [PMID: 37736914 PMCID: PMC10514880 DOI: 10.3390/pharmacy11050142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND A Best Possible Medication History (BPMH) collected by clinical pharmacists is crucial for effective medication review, but, in Italy, it is often left to the nursing staff. This study aims to compare the quality and accuracy of a clinical pharmacist-documented BPMH with the current standard practice of ward staff-collected BPMH in an Italian preoperative surgical setting. METHODS A 20-week prospective observational non-profit study was conducted in a major university hospital. The study comprised three phases: a feasibility, an observational, and an interventional phase. During the feasibility phase, 10 items for obtaining a correct BPMH were identified. The control group consisted of retrospectively analyzed BPMHs collected by the ward staff during the observational phase, while interventions included BPMHs collected by the clinical pharmacist during the third phase. Omissions between the two groups were compared. RESULTS 14 (2.0%) omissions were found in the intervention group, compared with 400 (57.4%) found in the controls (p < 0.05); data collection was more complete when collected by pharmacists compared to the current modality (98.0% of completed information for the intervention versus 42.6%; p < 0.05). CONCLUSIONS The involvement of a pharmacist significantly reduced the number of omissions in preoperative surgical-collected BPMHs. This intervention holds the potential to decrease the risk of medication errors associated with inaccurate or incomplete BPMHs prior to surgical hospitalization.
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Affiliation(s)
- Daniele Mengato
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Lisa Pivato
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Lorenzo Codato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Pharmacology Building, Via Marzolo 5, 35131 Padova, Italy
| | - Fernanda Fabiola Faccioli
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Laura Camuffo
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
| | - Maria Cecilia Giron
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Pharmacology Building, Via Marzolo 5, 35131 Padova, Italy
| | - Francesca Venturini
- Hospital Pharmacy Department, Padova University Hospital (Azienda Ospedale-Università Padova), Via Giustiniani 2, 35128 Padua, Italy
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