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A team of dedicated clinicians at PA Hospital’s Pharmacy have developed a successful nurse-administered medication risk screening tool that streamlines the pre-admission process for surgical patients.
Presented at the 2023 Metro South Health Sprint Series Showcase on 3 November, the Pre-admission Clinic (PAC) Review by Pharmacist project was initiated and led by Pharmacist Perioperative Team Leader, Kate Ziser in response to a gap in the pre-admission screening process that resulted in a large group of patients on high-risk medications not being seen by a pharmacist before surgery.
Deputy Director of Pharmacy Clinical Services and project collaborator, Libby Currey says the project refocused the screening process to better accommodate high-risk patients.
“Typically, the patients seen in the pre-admission clinic were those we needed to see for other tests. They were screened based on this need, not on the basis of what medications they’re on,” she said.
“The idea from Kate and her team was to implement a medication risk screening tool to be administered by nurses who could identify surgical patients on high-risk medications and refer them to the pre-admission clinic pharmacist. We tried to spend less time on the lower-risk patients who were coming in just to see an anaesthetist, while focusing more on patients on high-risk medicine.”
One of three initiatives submitted by the team at the Showcase, the PAC Pharmacist Review project was implemented over a two-month trial period. In that time, 81 referrals were made to the pre-admission pharmacist, 37 of which required pharmacist intervention. Libby says the resulting drop in same-day surgical cancellations during this time spoke to the project’s positive impact on patient outcomes.
“2022 baseline data captured by Kate showed that about three surgeries were cancelled per month on the day of surgery due to medication misadventure. That went down to zero in the first month of our trial,” she said.
Libby says the success of the project was representative of Pharmacy’s collaborative, forward-thinking culture and a collective drive to contribute to innovation and research in the field.
“We have a really enthusiastic, dynamic, and innovative department. Everyone who works here is happy to be here and I think that shows we have a strong culture,” said Libby.
“We also have great leadership in our team leaders and our Director, Michael Barras. Michael drives a culture of research within the department, and that encourages people to explore more research and quality improvement projects like this.”
After claiming a 2023 Metro South Health Sprint Series Showcase Award for their tireless efforts and successful project delivery, the Pharmacy team has their sights set on implementing the project as a long-term solution.
“We have made a really great change that we can certainly continue in some capacity, with an aim to recommence additional high-risk patient reviews in 2024. Our pre-admission clinic nurses did a wonderful job screening patients for us, and that support is vital to helping us manage the high volume of patients and improve our processes to manage low-risk patients more efficiently,” she said.
“The bigger goal is to increase our pre-admission clinic pharmacist resources to enable us to capture all of those high-risk patients that we can’t always see due to time and resource constraints. We hope this will be a stepping stone to that.”