Pharmacist‐driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery

Abstract

What is known and objective The incorrect or insufficient prophylaxis of postoperative nausea and vomiting (PONV) is common in practice. A clinical pharmacist‐led guidance team (CPGT) was established and included in general surgery teams. Objective This study aimed to evaluate the effects of the CPGT on the improvement of PONV and prophylaxis administration. Methods A prospective before‐after study was conducted on 156 female patients undergoing abdominal surgery at a Chinese tertiary teaching hospital from December 2016 to December 2017. A total of 82 patients were enrolled in the preintervention period, and 74 patients were included in the post‐intervention period. The CPGT established the evidence‐based criteria for prophylactic anti‐emetic administration and conducted interventions, including a review of medical records, provision of feedback, educational outreach, and dedicated support. Primary outcomes included the incidence of PONV within 24 hours of surgery, administered number of prophylactic anti‐emetics, and accuracy of the timing for prophylactic anti‐emetics. Outcomes were analysed by logistic regression or multivariable linear regression. Results and discussion After intervention, patients reported significantly less PONV (33.78% vs 56.10%; odds ratio [OR]: 0.29; numbers needed to treat [NNT]: 3.47), vomiting (29.73% vs 45.12%; OR: 0.42; NNT: 5.16) and nausea (31.08% vs 56.10%; OR: 0.24; NNT: 3.19) within 24 hours of surgery. The accuracy of the timing for prophylactic anti‐emetics significantly increased (OR: 3.66; P: .003). Anaesthesiologists administered increased numbers of prophylactic anti‐emetics (OR: 5.82; P < .001). The improvement of PONV did not decrease during the four‐month period after intervention (P: .639). What is new and conclusion The CPGT is a valuable service model to continuously improve PONV and optimize prophylaxis administration.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…A postoperative atrial fibrillation pathway has been developed, implemented, and successfully sustained that identifies and correct the underlying arrhythmic cause, as well as choosing a strategy for rate or rhythm control and determining thrombotic risk [ 146 ]. Prevention of PONV has been addressed through multidisciplinary patient-centered initiatives by implementing multi-modal strategies that capitalize on timely administration of agents with different mechanisms of action [ 147 , 148 ]. Three excellent examples of interprofessional collaboration and shared mental modeling for perioperative medication management applicable in ERPs include the online UK Handbook of Perioperative Medicines [ 149 ], a manual on decision making in perioperative care [ 150 ], and a handbook covering enhanced recovery optimization [ 151 ].…”

“…Pharmacists attached to various surgical services have provided consultation to anesthesiologists at the service and individual patient levels regarding local anesthetic systemic toxicity (LAST) and enhanced recovery analgesic/anesthetic pathways (in light of the recent move toward increased local anesthetic use to reduce opioid exposure) as well as evolving surgical techniques. Collaboration with surgeons has often focused on risk assessments and treatment recommendations for preoperative and pharmacokinetic-based antimicrobial optimization [ 157 ], VTE and PONV prophylaxis [ 144 , 147 ], postoperative pain management, POI mitigation, and electrolyte replacement and nutrition support, including glycemic control [ 158 ]. In one 20-month pre-/post-study in which clinical pharmacists were directly involved, pre-implementation colonic SSIs were reduced from 10% to 2%, VTE rate decreased from 0.6% to 0%, and postoperative readmission rate decreased from 4.8% to 1.3% [ 111 ].…”

Students’ experience and perception of a virtual surgical advanced pharmacy practice elective

“…As this rotation was offered to the at the last rotation of the year for this batch of students, all the interns had already completed their required rotations and more than 1500 hour of APPE. Although delivering this virtual rotation was a corrective response to the rapid changes that the college faced after the sudden prevention of hospitals and health centres from receiving students, it still did not affect the minimum requirements of APPE recommended by the ACPE The need for the involvement of clinical pharmacists in surgery and anaesthesia and their impact on improving patient outcomes throughout the surgical continuum of care is well-known; however, actual practice in this area is limited (Neville et al, 2014;Nguyen et al, 2020;Patel et al, 2020;Wang et al, 2020). The number of surgeries performed in Saudi Arabia in 2012 was 3,544 per 100,000 people, and it is expected to increase (Weiser et al, 2016).…”

“…Pharmacists' involvement in surgery is well established, and their role in enhancing the safety outcomes of perioperative patients and decreasing associated hospital costs is well-documented (Hick et al, 2001;Bond & Raehl, 2007;Charipiat et al, 2012;Neville et al, 2014;Bansal & Morris, 2019;Nguyen et al, 2020;Wang et al, 2020). Although the American Society of Hospital Pharmacy (ASHP) has consistently reported statements highlighting the role of clinical pharmacists in perioperative settings, its implementation in practice is limited and varied (American Society of Health-System Pharmacists., 2014;Hawkins et al, 2019;Patel et al, 2020).…”

Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs

“…A pharmaceutical assessment is conducted for patients admitted for elective surgery after pre-admission evaluation, which is throughout the whole process of ERAS. The key points of preoperative pharmaceutical care include (1) Preoperative medication education for patients; (2) The review of prescriptions based on outpatient pharmacy pre-assessment records to ensure high adherence to medication reconciliation [ 109 ]; and (3) For high-risk cases in preoperative assessment, individualized drug intervention plans are recommended to the ERAS treatment team before surgery to optimize ERAS medication treatment [ 106 , 110 ].…”