S urgical P re A dmission R eview C linics (SPARC)

1. Surgical Pre Admission Review Clinics (SPARC) Truc NguyenPharmacy Surgical Team Leader CMH Pharmacy

2. 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

3. 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

4. Initial patient flow Nurse Dr Pharmacist Methodology Phase One: Control phase • 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

5. Nurse Dr Pharmacist Initial patient flow Nurse Dr Pharmacist Nurse Pharmacist Dr Methodology Phase One: Control phase (110 patients) Phase 2: Intervention phase (140 patients)

6. Phase 1 Nurse Dr Pharmacist Results - Safety • Phase 1 = 110 patients

7. 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

8. Phase 1 = 110 patients

9. 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)

10. 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

11. Phase 2 Phase 1 Dr Pharmacist Nurse Nurse Dr Pharmacist Times taken at Pre-admission clinics =110 pts =140 pts P<0.05

12. 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…..

13. 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 pre-admission clinics”

14. 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)

15. 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??

16. THANK YOU!

17. What was the cost? • 0FTE 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

18. 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 peri-operative chest infection and intra-operative respiratory problems Referred to anaesthetic -> Respiratory review End result -> family discussion Example of Grade 4