Impact of the addition of clinical pharmacy services to the cardiac catheterization laboratory.

Abstract

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Our cardiology pharmacy team recently expanded services to the cardiac catheterization laboratory (CCL) with the addition of a dedicated pharmacist; since that time, numerous process improvement initiatives have been implemented and medication review has been expanded. We conducted a single-center retrospective chart review. The primary outcome was the percentage of patients discharged from the CCL on appropriate guideline-directed medical therapy components after percutaneous coronary intervention (PCI) before and after integration of dedicated pharmacist services in the CCL. Secondary outcomes were assessed for all patients discharged from the CCL after implementation of a pharmacy presence and included the total number of pharmacist interventions at discharge, the number of prescriptions directed to our outpatient pharmacy, the number of medication reconciliations performed, the number of "protect your stent" educational sessions completed, and the number of clinically significant pharmacist interventions to the medication regimens of patients who underwent PCI. After a dedicated pharmacist was integrated to review CCL discharges, significantly more patients were discharged on high-intensity statin therapy (47.9% vs 78.0%; P < 0.0001) and fewer patients were discharged on omeprazole or esomeprazole prescribed concurrently with clopidogrel (18.7% vs 3.9%; P < 0.0001) following PCI. Of the patients who underwent PCI after addition of the pharmacist (n = 259), 23.9% (n = 66) had a clinically significant pharmacist intervention at discharge and 96.5% (n = 250) received protect your stent education. Of all discharges following pharmacist integration (n = 3,501), 13.6% (n = 477) had at least one pharmacist intervention, 771 prescriptions were sent to our outpatient pharmacy, and 66.4% (n = 2,325) of patients had a medication reconciliation completed. Addition of a dedicated pharmacist to the CCL was associated with increased rates of high-intensity statin prescribing and decreased use of esomeprazole and omeprazole with clopidogrel.