Role of a hospital pharmacist in cardiac day procedure ward: a prospective observational study

Abstract

Abstract Background The cardiac day procedure ward provides peri-procedural care to elective patients attending hospital for a broad range of diagnostic and interventional cardiac catheterisation procedures. In this acute setting, changes to patients' medication regimen can often occur, however patient-completed questionnaires are often inaccurate.1,2 Australian standards recommend that an accurate medication history be obtained, and medication reconciliation performed for all patients.3 A plan for cessation and restarting of relevant medications should also be documented.1 However, the role of a pharmacist in this setting has not been widely studied. Purpose The aim of this study is to evaluate the role of a pharmacist in a cardiac day procedure ward and identify patient groups who may benefit from a pharmacist medication review. Methods A prospective, observational study was conducted over 5 weeks (24/2/20–27/3/20) in a cardiac day procedure ward at a major tertiary referral centre, in a multi-site Australian metropolitan hospital network. An 8-hour per day clinical pharmacy service was provided to the ward, which is open approximately 12 hours per day. Results In the study period, 297 patients presented to the ward, and 79% (234/297) received a pharmacist medication review (a systematic assessment of a patient's medication management to optimise treatment outcomes). Elective day procedures were planned for 247 patients, and in 74% (182/247) a pharmacist documented a best possible medication history (comprehensive list of a patient's prescription and non-prescription medicines using two or more information sources). Medication-related problems were identified in 51 patients, with the majority (79%, 70/89) in patients presenting for coronary angiography. 93% (83/89) of interventions were accepted after discussion with the hospital resident medical officer or interventionalist. The remainder (7%, 6/89) were not enacted as further monitoring of vital signs or cardiologist follow-up was needed. Following their procedure, 155 patients returned to the ward for recovery. A specific plan for continuation, cessation or restarting of medications post-procedure was initially documented for 16% (25/155) of patients by catheterisation laboratory staff, and increased to 90% (140/155) with pharmacist medication review. Prescriptions for medications changes were required in 25% (38/155) of patients, and prescription medication counselling was provided by the pharmacist for all patients. Conclusion Pharmacists can optimise medication management of patients in cardiac day procedure wards by obtaining an accurate medication history, identifying medication related problems, and documenting a post-procedure medication plan; particularly for patients presenting for coronary angiography. While this study supports the embedding of a clinical pharmacy service in cardiac day procedure wards, more research is needed to fully elucidate the impact on patient outcomes. Funding Acknowledgement Type of funding sources: None.