Impact of clinical pharmacist interventions on inappropriate prophylactic acid suppressant use in hepatobiliary surgical patients undergoing elective operations

Abstract

ObjectiveTo evaluate the impact and cost-benefit of clinical pharmacist interventions on inappropriate use of prophylactic acid suppressant in hepatobiliary surgical patients in a Chinese tertiary hospital.MethodsA retro-prospective intervention study of patients undergoing elective operations was performed in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University. Patients admitted from October to December 2015 and from October to December 2016, served as the pre-intervention and the post-intervention group, respectively. Clinical pharmacist interventions in the post-intervention group included real-time monitoring medical records and recommending that surgeons prescribe prophylactic acid suppressants according to the criteria established by the hospital administration. Then, the clinical outcomes of post-intervention group were compared with the pre-intervention group which lacked pharmacist interventions. In addition, cost-benefit analysis was conducted to determine the economic effects of implementing the clinical pharmacist interventions in acid suppressant prophylaxis in perioperative period.ResultsClinical pharmacist interventions significantly decreased the rate of the use of no indications for prophylactic acid suppressant and of the cases of inappropriate drug selection, dose, route, replacement and prolonged duration of prophylaxis (P < 0.05 or P < 0.001), resulting in significant increase by 10.65% in the percentage of cases adhering to all the criteria (P < 0.001). Moreover, significant reductions were found in the average usage quantity (P<0.001), mean cost (P = 0.03) and mean duration (P < 0.001) of prophylaxis acid suppressant. The ratio of the mean cost savings for acid suppressants to the mean cost of pharmacist time was 13.61:1.ConclusionThe clinical pharmacist’s real-time interventions facilitated the rational use of prophylactic acid suppressant and resulted in favorable economic outcomes in hepatobiliary surgery.

Interventional effect of off-label use of alprostadil lipid microsphere injection in neurosurgical patients: a before-after study

“…Another study showed that off-label drug use was found in 25 out of 36 clinical departments in a tertiary hospital in China [17] launched. Our previous study has confirmed that the clinical pharmacist's real-time interventions facilitated the rational use of prophylactic acid suppressant and resulted in favorable economic outcomes [19]. However, considering the current increase in the number of beds and the serious shortage of clinical pharmacists in our hospital, we decided to implement simple administrative intervention from January 1, 2018 to December 31, 2018 in present study in order to decrease the inappropriate use of Lipo-PGE 1 and to reduce Lipo-PGE 1 costs.…”

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

“…Another approach to reach improved outcomes in patient care within the perioperative area is the expansion of collaborative practice agreements (CPAs). CPAs between surgeons and pharmacists have demonstrated improved medication management and safety in multiple perioperative settings . These agreements often allow the PCPh to assess, review, and modify drug therapy independently, allowing the pharmacist to practice at the highest level within licensure.…”

“…These agreements often allow the PCPh to assess, review, and modify drug therapy independently, allowing the pharmacist to practice at the highest level within licensure. Examples of potential targets for CPAs may include the management of pain, delirium, gastric acid secretion, antimicrobial prophylaxis, blood glucose, and anticoagulation based on previously reported outcomes …”

“…CPAs between surgeons and pharmacists have demonstrated improved medication management and safety in multiple perioperative settings. 18,20 These agreements often allow the PCPh to assess, review, and modify drug therapy independently, allowing the pharmacist to practice at the highest level within licensure.…”

“…Examples of potential targets for CPAs may include the management of pain, delirium, gastric acid secretion, antimicrobial prophylaxis, blood glucose, and anticoagulation based on previously reported outcomes. 18,21,[56][57][58][59] Telemedicine-based clinician support systems, when applied to the…”