Background and Importance

The preoperative setting is an area with high risk for medication errors with potentially severe consequences. Pharmaceutical care programmes(PCP) can help to achieve an adequate preoperative pharmacological management, to ensure patients reach surgery in optimal pharmacological conditions. Adequate coordination with other specialists such as surgeons and anaesthetists is paramount to guarantee patient safety.

Aim and Objectives

To evaluate the impact of a PCP in patients undergoing cardiac surgery in preventing medication errors after 4 years of implementation.

Material and Methods

Retrospective, observational, descriptive study. Time of study: July 2018-July 2022. All patients scheduled for cardiac surgery were interviewed by a clinical pharmacist 24-72h before the surgery. Interviews were conducted by phone. During the interview, patients’ complete medication list, including over the counter medicines and herbal products, was collected and instructions for adequate preoperative medication management according to current guidelines and anaesthetist instructions were reinforced. Avoided medication errors were categorised according to Overhage-classification and their severity was analysed according to NCC-MERP. Savings were calculated by multiplying the probability of adverse event occurrence with the error(NCC-MERP≥F:high risk of admission or prolonged hospital stay) by avoided cost(6.745€ according to Ministry of Health, Consumer and Social Welfare).

Results

During the time of study, 1020 pharmacist preoperative interviews were performed. Mean age was 66.8(sd:12.6) years and 65.8% of the interviewed patients were males. 41.8% of patients were taking at least one drug that needed to be discontinued before surgery. The most frequent were angiotensin-converting enzyme inhibitors, angiotensin-II receptors blockers and diuretics(23.6%), anticoagulants and antiplatelet treatment(22.2%) and hypoglycaemic treatment(11.4%). 43.5% of patients needed heparin bridge therapy. A total of 807 pharmacy interventions were conducted with 94.2% of acceptance rate: 533 requirements to discontinue drugs before surgery(70.1%), 81 dose error(10.7%), 49 drug omission(6.4%), 32 associated with duration, frequency or indication(4.2%). 673 serious errors were avoided, 236(31.1%) of these errors could have resulted in permanent harm(G/H), 277(36.4%) in temporary harm(E/F) and 160(21.1%) monitoring patients to confirm no harm(D). Potential medication errors avoided an estimated cost of 992.130€.

Conclusion and Relevance

A PCP in patients undergoing cardiac surgery was successfully implemented, ensuring a correct preoperative drug management, with 0.8 severe medication errors avoided per patient that was interviewed and potential savings of 992.130€.

References and/or Acknowledgements

Conflict of Interest

No conflict of interest