Prior to this improvement initiative the preadmission clinic (PAC) at the Princess Alexandra Hospital (PAH) was designed on the screening of patients for a clinic appointment based on an anaesthetic referral criteria. Those who met the anaesthetic referral criteria attended PAC either in person or via a telephone appointment and were reviewed by PAC pharmacists regardless of medication type. Patients who did not meet the criteria were reviewed by PAC nursing staff only. If any medication adjustments were required, nursing staff referred these patients back to the surgical team for perioperative medication plans. A limitation to this system was that the PAC pharmacists did not review all patients on high-risk medications prior to surgery, subsequently leading to patients being cancelled on their day of surgery. This not only resulted in lost revenue for the hospital, but more importantly, led to sub-optimal patient outcomes and care.
This project was initiated to implement a high-risk medication-based referral criteria for patients who did not meet anaesthetic criteria and only seen by PAC nursing staff. This medication-based referral criteria aimed to identify patients taking high risk medications, to ensure a review by PAC pharmacists prior to surgery. Examples of high-risk medications included anticoagulants, antiplatelets, immunomodulators and insulin. PAC patients screened via the normal anaesthetic criteria were still seen by a pharmacist to ensure current ABF revenue was maintained.
Before developing the medication-based referral criteria, meetings were conducted with relevant stakeholders including PAC nursing staff, other pharmacists and Division of Surgery executives. Early engagement on the solution was critical. The medication-based screening tool also included certain high-risk patient cohorts such as those requiring ICU admission postoperatively, patients with Parkinson's disease, or those with complex perioperative pain management issues.
Once the screening tool was finalised, education was provided to the PAC nursing staff by the PAC nurse unit manager and PAC pharmacist. Nursing staff were educated on how to use the screening tool within their current workflows. Following education, the sprint trial was then implemented over a two-month period. During this time, nursing staff referred the high-risk patients to the PAC pharmacists. Importantly, low risk patients were still reviewed by the pharmacist.
The positive outcomes of the project resulted in additional funding that was granted by the Executive to continue the service. This will help collect further data that will support publication in the future.
This project was part of the Metro South Health (MSH) Clinical Improvement Unit's (CIU) 'Sprint series'.
