Optimized and cost-effective pharmacotherapy of vascular surgery patients: evaluation of clinical pharmacy service

BACKGROUND: The aim of this study was to determine a possible role for a pharmacist on a vascular surgery ward to optimize patient’s therapy and evaluate a newly implemented clinical pharmacy service by determining both the frequency and type of interventions performed together with their acceptance and economic impact.METHODS: One pharmacist was placed on a vascular surgery ward. Routine activities included participation in medical rounds, obtaining and reviewing patient’s medication profiles together with daily review of laboratory results, advising patients and medical staff on correct use of medicines. Drug-related recommendations were made where necessary. All interventions were recorded daily and put in a database according to the following categories: types of recommendations, stage of patient’s hospitalization at which it occurred, therapeutic class of medicines involved. In addition, frequency and acceptance rate of suggestions were monitored during the process.RESULTS: Over 12-months pharmacist performed 1349 interventions, of which 97% were accepted by surgeons. The most frequent type of intervention was drug discontinuation, followed by addition of new or missing drug and dose adjustment route. Cost-avoidance due to the prevention of Adverse Drug Events (ADEs) and cost-savings on direct medicines cost were estimated to be 318,835 zloty ($88,271, €74,766) and 30 000 zloty ($8306, €7035) respectively with cost benefit ratio of 1:9.5.CONCLUSIONS: We conclude that pharmacist involvement in direct patient care can help delivering optimised and cost-effective medicines use for patients by providing recommendations for changes to be made to their pharmacotherapy which are well perceived by surgeons.