Abstract：
The accuracy and timeliness of documenting a medication history is an important aspect to ensure appropriate medication reconciliation during transitions of care. Surgical patients often have their medication history recorded just moments before surgery which may be rushed, incomplete or missed entirely. Between January and May 2020, 76.7% of surgical patients admitted to our institution had a medication history completed by a pharmacist prior to surgery.
The objective of this work is to improve the pharmacist medication history completion rates for pre-surgical patients before surgery by integrating pharmacist-led medication histories into the pre-operative pathway.
Through interdisciplinary collaboration, the pre-operative pathway for surgical patients was evaluated for opportunities to complete medication histories days prior to their scheduled procedure. Plan-Do-Study-Act (PDSA) cycles were utilized to make incremental improvements in practice.
Through an iterative process, the pathway for cardiovascular surgery (CVS) patients was modified to include a scheduled pharmacist phone appointment in the days leading up to their surgical procedure. Utilizing these phone appointments, pharmacists complete patient medication history reviews and share a feedback loop to cardiovascular and peri-operative health care providers.
The iterative PDSA cycles revealed challenges to completing pre-surgical medication history calls without advance notice. Patient responsiveness to pre-surgical medication history calls improved with the incorporation of scheduled phone appointments. Between January 18 and May 31, 2021, pharmacists completed 359 of 376 scheduled CVS appointments (95.5%), improving the medication history completion rates for cardiovascular surgery patients from 84.8 to 93.0% (p = 0.000025). The completion rate for all surgical patients also improved from 76.7 to 85.1% (p < 0.00001).
Incorporating scheduled pharmacist medication history appointments as a part of the pre-operative pathway was shown to expand the capacity for pharmacists to complete medication histories for patients prior to surgery. By reducing pharmacist workload on the morning of surgery, fewer patients were admitted to surgery without having their medication history reviewed by pharmacy. Future investigation should be considered to evaluate the impact on patient outcomes.
The objective of this work is to improve the pharmacist medication history completion rates for pre-surgical patients before surgery by integrating pharmacist-led medication histories into the pre-operative pathway.
Through interdisciplinary collaboration, the pre-operative pathway for surgical patients was evaluated for opportunities to complete medication histories days prior to their scheduled procedure. Plan-Do-Study-Act (PDSA) cycles were utilized to make incremental improvements in practice.
Through an iterative process, the pathway for cardiovascular surgery (CVS) patients was modified to include a scheduled pharmacist phone appointment in the days leading up to their surgical procedure. Utilizing these phone appointments, pharmacists complete patient medication history reviews and share a feedback loop to cardiovascular and peri-operative health care providers.
The iterative PDSA cycles revealed challenges to completing pre-surgical medication history calls without advance notice. Patient responsiveness to pre-surgical medication history calls improved with the incorporation of scheduled phone appointments. Between January 18 and May 31, 2021, pharmacists completed 359 of 376 scheduled CVS appointments (95.5%), improving the medication history completion rates for cardiovascular surgery patients from 84.8 to 93.0% (p = 0.000025). The completion rate for all surgical patients also improved from 76.7 to 85.1% (p < 0.00001).
Incorporating scheduled pharmacist medication history appointments as a part of the pre-operative pathway was shown to expand the capacity for pharmacists to complete medication histories for patients prior to surgery. By reducing pharmacist workload on the morning of surgery, fewer patients were admitted to surgery without having their medication history reviewed by pharmacy. Future investigation should be considered to evaluate the impact on patient outcomes.
摘要：
背景：记录用药史的准确性和及时性是确保在护理过渡期间进行适当的药物核对的重要方面。手术患者通常会在手术前一刻记录他们的用药史，不完整或完全错过。在2020年1月至5月之间，我们机构收治的76.7％的手术患者在手术前有药剂师完成的用药史。
目的：这项工作的目的是通过将药师主导的用药史纳入术前途径，提高术前患者的药师用药史完成率。
方法：通过跨学科合作，对手术患者的术前途径进行了评估,以确定在预定手术前几天完成用药史的机会.利用计划-做-研究-行动(PDSA)周期在实践中进行增量改进。
方法：通过迭代过程，对心血管手术(CVS)患者的治疗途径进行了修改,包括在手术前几天安排药剂师电话预约.利用这些电话预约，药剂师完成患者用药史回顾,并与心血管和围手术期医疗保健提供者共享反馈循环.
结果：重复的PDSA周期显示，在没有事先通知的情况下完成手术前用药史的要求面临挑战。患者对术前用药史呼叫的反应性随着计划电话预约的合并而改善。在2021年1月18日至5月31日期间，药剂师完成了376项预定CVS预约中的359项（95.5％），将心血管手术患者的用药史完成率从84.8%提高到93.0%(p=0.000025).所有手术患者的完成率也从76.7％提高到85.1％（p<0.00001）。
结论：将预定的药剂师用药史预约作为术前途径的一部分被证明可以扩大药剂师在手术前完成患者用药史的能力。通过减少手术早晨的药剂师工作量，较少患者接受手术治疗,但未通过药房审查其用药史.未来的调查应考虑评估对患者预后的影响。
目的：这项工作的目的是通过将药师主导的用药史纳入术前途径，提高术前患者的药师用药史完成率。
方法：通过跨学科合作，对手术患者的术前途径进行了评估,以确定在预定手术前几天完成用药史的机会.利用计划-做-研究-行动(PDSA)周期在实践中进行增量改进。
方法：通过迭代过程，对心血管手术(CVS)患者的治疗途径进行了修改,包括在手术前几天安排药剂师电话预约.利用这些电话预约，药剂师完成患者用药史回顾,并与心血管和围手术期医疗保健提供者共享反馈循环.
结果：重复的PDSA周期显示，在没有事先通知的情况下完成手术前用药史的要求面临挑战。患者对术前用药史呼叫的反应性随着计划电话预约的合并而改善。在2021年1月18日至5月31日期间，药剂师完成了376项预定CVS预约中的359项（95.5％），将心血管手术患者的用药史完成率从84.8%提高到93.0%(p=0.000025).所有手术患者的完成率也从76.7％提高到85.1％（p<0.00001）。
结论：将预定的药剂师用药史预约作为术前途径的一部分被证明可以扩大药剂师在手术前完成患者用药史的能力。通过减少手术早晨的药剂师工作量，较少患者接受手术治疗,但未通过药房审查其用药史.未来的调查应考虑评估对患者预后的影响。
