1019: SURGICAL PHARMACISTS PERI-OP[EN] THE DOOR TO IMPROVED TRANSITIONS OF CARE

Abstract

Introduction: Surgical patients pass through a myriad of transitions of care during their hospitalization. Often in elective procedures, patients will undergo surgery and immediate post-operative care prior to pharmacist profile review. Many patients, however, may be on high-risk medications per the Institute for Safe Medication Practices (ISMP) that need immediate attention in the perioperative setting. Additionally, intensive care units (ICU) are consistently at capacity, and therefore ways to decrease this burden should be optimized. Recognizing this, subspecialty surgical pharmacists began preoperatively reviewing patients. Methods: A pilot process of preemptive patient review of 412 elective surgical patients was established to assess home medications and pertinent past medical history. The goal was to prevent intra- and post-operative medication-related complications that may translate to poor surgical outcomes, admission to the ICU, or increased length of stay. The service line pharmacist would work with the perioperative pharmacist, surgeons, and anesthesiologists to optimize care, discuss potential barriers, and develop a plan. Results: 295 patients (71.6%) were identified to have 1 or more high-risk medications, with a range of 0-6 medications per patient, that required intervention or coordination of care. Some examples of interventions include: reducing missed doses of seizure mediations, identifying patients that may need intra-operative insulin drips to prevent DKA, identifying the need for stress dose steroids perioperatively to avoid shock, preventing post-operative atrial fibrillation by resuming home beta blockers, identifying intrathecal baclofen pumps, facilitating initiation of heart rate and blood pressure lowering medications in patients with strict hemodynamic goals, and coordinating with anesthesiologists and surgeons regarding intraoperative pain management for chronic pain patients. Conclusions: Preoperative review of elective surgical patients’ home medications and pertinent past medical history by a pharmacist can aid in improved transitions of care. Developing care plans and facilitating these transitions has the potential to decrease poor surgical outcomes, avoid unnecessary admission to the ICU, and decrease length of stay.