Evaluation of An Inpatient Pharmacy Consult on Discharge Medications in Bariatric Surgery Patients
| Autor: | Jessica L. Hicks, Amanda M. Van Prooyen, S. Scott Davis, DeAngelo A. Harris, Edward Lin, Elissa A. Falconer, Arvinpal Singh, Elizabeth M. Hechenbleikner |
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| Rok vydání: | 2021 |
| Předmět: |
Medication review
medicine.medical_specialty business.industry Pharmacy 030204 cardiovascular system & hematology Surgery 03 medical and health sciences 0302 clinical medicine Pharmacotherapy medicine Pharmacology (medical) 030212 general & internal medicine Discharge medications business Patient education |
| Zdroj: | Journal of Pharmacy Practice. 36:203-212 |
| ISSN: | 1531-1937 0897-1900 |
| DOI: | 10.1177/08971900211030238 |
| Popis: | Purpose: To evaluate the impact of an inpatient pharmacy consult on discharge medications following bariatric surgery. Methods: A pharmacy consult for discharge medication review for bariatric surgery patients was instituted at an academic medical center. The intervention included conducting a medication history, reviewing home medications for updates post-bariatric surgery, creating and documenting a discharge medication plan, and providing patient education. The impact of the intervention was evaluated by comparing medication classes, doses, and formulations prescribed during the intervention relative to a historical control group. Results: The study included 85 patients who received pharmacist intervention and 167 patients who did not receive pharmacist intervention following bariatric surgery. The prescription of an extended-release medication at discharge in the intervention group was reduced by 19.3% (28.7% vs. 9.4%, p = 0.0005). For patients on hypertension medications, 94.0% had their regimen reduced in the intervention group compared with 37.5% of patients in the control group (p < 0.001). Of patients on insulin at baseline, 87.5% of patients in the intervention group had dose reductions at discharge vs. 66.7% of patients in the control group (p = 0.37). No patients in the intervention group were discharged with oral antihyperglycemic medications or non-insulin injectable medications vs. 33.3% (p = 0.12) and 20.0% (p = 0.47), respectively, in the control group. Readmission rates at 30 days were insignificantly lower in the intervention group (3.5% vs. 4.2%, p = 1). Conclusions: Clinical pharmacist involvement in the discharge medication reconciliation process for bariatric surgery patients reduced prescribing of unadjusted medication classes, doses, and drug formulations. |
| Databáze: | OpenAIRE |
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