Remote pharmacist consultations enhance post-COVID-19 surgical capacity
To address a significant loss of elective surgery capacity during the COVID-19 pandemic, New Stobhill Ambulatory Care Hospital in NHS Greater Glasgow and Clyde began performing hip and knee arthroplasty as day case procedures. However, Stobhill had limited pharmacy resources and NHS Greater Glasgow and Clyde did not have an existing preoperative pharmacist service. Without preoperative pharmacist input, the day case arthroplasty service could have faced cancellations or complications related to medicines. They were also concerned about variations in practice and delays in patient discharge resulting from anaesthetic and surgical staff prescribing discharge medicines on the day of surgery.
To tackle these problems, colleagues from pharmacy, physiotherapy, and anaesthetics came together to develop an innovative preoperative pharmacy service. Their aim was to facilitate day case arthroplasty by providing much-needed pharmacy support and avoiding medicines-related cancellations. They also aimed to support efficient discharge and reduce the length of stay in hospital, improve prescribing quality by standardising prescribing practices, and empower patients to make decisions about their own pharmaceutical care.
Developing a preoperative pharmacy service
To start off, the wider orthopaedic multidisciplinary team (MDT) agreed on standardised protocols for discharge prescribing and postoperative thromboprophylaxis. Next, an independent prescriber pharmacist contacted all patients listed for total or unicompartmental knee replacement (TKR or UKR) and total hip replacement (THR) by telephone 1-2 weeks before their surgery. The pharmacist then wrote, signed, and emailed each patient’s discharge prescriptions so they could be dispensed before the patient was admitted for surgery.
Evaluating the new process
To determine whether the new pharmacy service was a success, the team collected prescribing data for 80 patients who had a UKR, TKR or THR before the new pharmacy service was introduced, for 129 patients who had these procedures afterwards, and also for all interventions completed by the pharmacist prescriber during each consultation. This data was evaluated for clinical significance by two pharmacist prescribers. The team also created an anonymous online questionnaire using Microsoft Forms, and sent it to Surgeons, Anaesthetists, Nurses, and Physiotherapists from the orthopaedic multidisciplinary team, asking their opinions of the changes to the service. The nursing team for the day surgery unit also collected patient opinions by calling patients a week after they were discharged from hospital.
Upon reviewing the patients seen after the pharmacy service began, 74.8% of interventions were of a significance expected to produce improvement in patient care. The review of patients seen before the pharmacy service began revealed that a pharmacist would have prescribed differently for 44.8% of patients. Patient feedback was very positive, with 100% of those surveyed reporting that they felt more confident taking pain medication after speaking to a pharmacist, and 73% of patients who had had a previous surgery stating that the experience was “much better” with the new pharmacy service. 79% of staff surveyed said that the new pharmacy service allowed them to have more time to spend on clinical care of patients, and 100% of staff said the service increased the efficiency of medicine supply and also improved prescribing standards. There was also a statistically significant reduction in the number of encounters patients needed after discharge, in patients who received a preoperative pharmacy review.
Overall, the orthopaedics team believes the new pharmacy service improves prescribing standards and patient safety, improves the patient experience, reducing surgical burden on the system, and dramatically reduces the length of stay for arthroplasty patients in Glasgow. The orthopaedics team created a poster about the development of the pharmacy service, which can be viewed here.