Integrating a pharmacist into the perioperative setting
Tori G. Forrester A H , Sara Sullivan B , Centaine L. Snoswell
A C , Peter Pillans D E , Michael Barras A F and David Sturgess E G
A Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: c.snoswell@uq.edu.au, michael.barras@health.qld.gov.au
B Metro South Health, Building 5, Garden City Office Park, 2404 Logan Road, Eight Mile Plains, Qld 4113, Australia. Email: sara.sullivan@health.qld.gov.au
C Centre for Health Services Research, The University of Queensland, 34 Cornwall Street, Woolloongabba, Qld 4102, Australia.
D Department of Clinical Pharmacology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: peter.pillans@health.qld.gov.au
E Faculty of Medicine, The University of Queensland, 20 Weightman Street, Herston, Qld 4006, Australia. Email: d.sturgess@uq.edu.au
F School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Qld 4102, Australia.
G Department of Anaesthesia, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
H Corresponding author. Email: Victoria.Forrester@health.qld.gov.au
Australian Health Review 44(4) 563-568 https://doi.org/10.1071/AH19126
Submitted: 30 May 2019 Accepted: 12 September 2019 Published: 20 March 2020
Abstract
This paper describes the integration of a pharmacist into a perioperative environment and the ensuing quality and economic benefits. Deficiencies were identified in medication management in operating theatres (OT) at a large tertiary hospital. A perioperative pharmacist was employed for a 6-month pilot period, with permanent funding dependent on demonstration of agreed economic benefits. A multidisciplinary committee set goals, drove strategic initiatives and was accountable for delivery of outcomes. Pharmaceutical expenditure was analysed and high expenditure items targeted. Cost savings and staff satisfaction were measured at 6 months. Savings of A$63 884 were achieved during the pilot period, resulting from optimised pharmaceutical unit pricing, OT medication stock on hand (imprest) review and redesigned medication management strategies. Improvements in medication management included better access to medications in the OT, rationalising available products to minimise wastage and implementation of guidelines and protocols for high-cost and high-risk medications. At 6 months, 97% of theatre staff supported continuation of the role; the project was extended with demonstrated cost savings of A$157 265 at 12 months. The integration of a perioperative pharmacist resulted in cost savings and medication management improvements in the OT setting. A permanent position was funded.
What is known about the topic? Medication use in OTs involves high volumes of high-risk and high-cost medications. Historically, there has been little pharmacist involvement in OTs, even though evidence has shown that hospital pharmacists can reduce medication errors, improve patient safety and reduce costs.
What does this paper add? This paper provides an overview of the process of establishing a perioperative pharmacist role in an adult tertiary hospital. It takes readers through the journey from pre-implementation audit to trial development, stakeholder consultation and specific medication and process targets.
What are the implications for practitioners? Hospitals and practitioners are faced with the challenge of improving service delivery within the constraints of a finite budget. This paper allows readers to learn from our experience and apply these learnings to their local hospital setting, ultimately improving both patient care and staff satisfaction through the development of a perioperative pharmacist service.
References
[1] Wahr JA, Abernathy JH, Lazarra EH, Keebler JR, Wall MH, Lynch I, Wolfe R, Cooper RL. Medication safety in the operating room: literature and expert-based recommendations. Br J Anaesth 2017; 118 32–43.| Medication safety in the operating room: literature and expert-based recommendations.Crossref | GoogleScholarGoogle Scholar | 28039240PubMed |
[2] Nanji KC, Patel A, Shaikh S, Seger DL, Bates DW. Evaluation of perioperative medication errors and adverse drug events. Anesthesiology 2016; 124 25–34.
| Evaluation of perioperative medication errors and adverse drug events.Crossref | GoogleScholarGoogle Scholar | 26501385PubMed |
[3] American Society of Health-System Pharmacists ASHP guidelines on surgery and anesthesiology pharmaceutical services. Am J Health Syst Pharm 1999; 56 887–95.
| ASHP guidelines on surgery and anesthesiology pharmaceutical services.Crossref | GoogleScholarGoogle Scholar | 10344614PubMed |
[4] Booth JC, Garrett MK, Taylor SE, Trajceska L. Establishing clinical pharmacy services in the operating suite. J Pharm Pract Res 2012; 42 296–9.
| Establishing clinical pharmacy services in the operating suite.Crossref | GoogleScholarGoogle Scholar |
[5] Powell PJ, Maland L, Bair JN, McCall JD, Wong KC. Implementing an operating room pharmacy satellite. Am J Hosp Pharm 1983; 40 1192–8.
| Implementing an operating room pharmacy satellite.Crossref | GoogleScholarGoogle Scholar | 6881158PubMed |
[6] Brakebill JI, Schoeneman PF, Buchanan B. Effective management strategy for establishing an operating room satellite pharmacy. Hosp Pharm 1988; 23 961–8.
| 10312768PubMed |
[7] Stroup JW, Iglar AM. Implementation and financial analysis of an operating room satellite pharmacy. Am J Hosp Pharm 1992; 49 2198–202.
| Implementation and financial analysis of an operating room satellite pharmacy.Crossref | GoogleScholarGoogle Scholar | 1524061PubMed |
[8] Keicher PA, McAllister JC. Comprehensive pharmaceutical services in the surgical suite and recovery room. Am J Hosp Pharm 1985; 42 2454–62.
| Comprehensive pharmaceutical services in the surgical suite and recovery room.Crossref | GoogleScholarGoogle Scholar | 4073062PubMed |
[9] Opoien D. Establishment of surgery satellite pharmacy services in a large community hospital. Hosp Pharm 1984; 19 485–90.
| 10317500PubMed |
[10] Buchanan EC, Gaither MW. Development of an operating room pharmacy substation on a restricted budget. Am J Hosp Pharm 1986; 43 1719–22.
| Development of an operating room pharmacy substation on a restricted budget.Crossref | GoogleScholarGoogle Scholar | 3752108PubMed |
[11] Kihira K. The role of the pharmacist in the management of the operating room. Masui – Jpn J Anesthesiol 2012; 61 267–75.
[12] Bui T. UK and US perioperative pharmacists’ experience. J Pharm Pract Res 2012; 42 314
[13] Singh HJ, Waddell JJ, Yeoh CG, Porter SA. Medication management in the operating suite. J Pharm Pract Res 2016; 46 316–23.
| Medication management in the operating suite.Crossref | GoogleScholarGoogle Scholar |
[14] Australian Commission on Safety and Quality in Health Care. Chapter 6: Labelling in perioperative areas. In: National standard for user-applied labelling of injectable medicines, fluids and lines. 2015. Available at: https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Standard-for-User-Applied-Labelling-Aug-2015.pdf [verified 22 May 2019].
[15] Malignant Hyperthermia Australia and New Zealand. Malignant hyperthermia resource kit. 2018. Available at: http://malignanthyperthermia.org.au/wp-content/uploads/2018/09/MALIGNANT-HYPERTHERMIA-RESOURCE-KIT-2018-1.pdf [verified 22 May 2019].
[16] Australian Commission on Safety and Quality in Health Care. Action 4.1: Integrating clinical governance. In: Medication safety standard: clinical governance and quality improvement to support medication management. 2019. Available at: https://www.safetyandquality.gov.au/standards/nsqhs-standards/medication-safety-standard/clinical-governance-and-quality-improvement-support-medication-management/action-41 [verified 22 May 2019].
