Category: Fellows Posters
Surgery complications are one of the hospital quality indicators. In addition, wrong drug management can also lead to surgery suspension.
The aim was to assess a perioperative pharmaceutical care program designed to improve safety of preoperative chronic drugs, antibiotic prophylaxis and health outcomes in orthopaedic patients.
A comprehensive pharmaceutical care program was implemented in September 2017. Pharmacist consultations were scheduled two days before total knee o total hip surgery. During the interview, the pharmacist checked patient´s treatment including any OTC and/or herbal remedies, evaluate patient understanding about correct administration of chronic drugs, make new recommendations if necessary and document all information in the patients’ medical records. The pharmacist also checked S. Aureus nasal exudate result and complete blood count test. Nasal mupirocin was dispensed when necessary, accompanied by topical chlorhexidine 4% flasks and written information instructions.
An observational prospective study was carried out. Patients attending the pharmaceutical consultation from September 2017 to August 2019 were included. Pharmacists’ interventions classified according to Overhage classification and the severity of medication errors according to NCC MERP were analysed as the impact on antibiotic prophylaxis.
788 patients were attended in the pharmacist consultation, mean age 72.1(SD=12.2) years, 37.4% male. Mean number of chronic drugs were 5.4(SD=3.8); 87 patients were on anticoagulants, 149 on antiplatelet and 103 on herbal products.
148 nasal exudate were positive so topical mupirocine was dispensed and 7 were methicillin-resistant therefore vancomycin was added to general antibiotic prophylaxis prior surgery.
In 521(66%) patients, there were chronic drugs that should be modified prior surgery. Drug classes most commonly involved were antidiabetics, thyroid hormones and antihypertensive drugs. 180 patients did not remember the anesthetic recommendations. 340 interventions were recorded and classified as inappropriate drug prior surgery (n=195), drug omission (n=91), wrong dose (n=29) and others (n=25). Examples of interventions: suspension of metformin prior surgery, administration of levotiroxine prior surgery or information reinforcement to patients. The anticoagulant treatment was modified in 22 patients (wrong dose/timing of thromboembolic prophylaxis, suspension of acenocoumarol, etc).
According to the medication errors’ severity, 7(2.1%) were serious G/H (5 regarding anticoagulation therapy), 260(76.5%) were serious D/E/F, and 73(21.4%) classified as potential error without harm (C).
Regarding health outcomes, one surgery suspension was recorded due to wrong perioperative medication management, 35(4.4%) were readmitted into the hospital and 8(1.0%) developed a prosthetic infection.
The perioperative pharmaceutical care program including a pharmacist consultation helps to the safety management of chronic medications and to the correct antibiotic prophylaxis in orthopedic patients.