Impact of clinical pharmacy services on the surgical care improvement project measures in a community hospital

Purpose: To assess and evaluate the impact of clinical pharmacy services on increasing and maintaining compliance with the Centers of Medicare and Medicaid services (CMS) surgical care improvement project (SCIP) hospital quality initiatives.

Methods: Two-thousand and eleven SCIP indicator baseline data was obtained and evaluated.  Aspects where pharmacy services would provide direct impact were identified - appropriateness, duration, and timeliness of antibiotics, venous thromboembolism (VTE) prophylaxis, and beta-blocker administration within 24 hours.  Preprinted order forms for surgical procedures, as well as a VTE preprinted order form was developed.  Pre and post surgical procedure antibiotics and number of doses immediately following surgery were streamlined to comply with current recommendations.  Alternative agents in patients with allergies were also included as to avoid delays in post-operative therapy.  Electronic "pop-up" windows that included surgical end times were implemented at time of order entry to aid the pharmacist in complying with antibiotic discontinuation in less than 24 hours of the surgical end time.  A daily SCIP list was provided to all pharmacist prior to surgery to aid in identification.  Additionally, a computer generated core measure report, which included SCIP, and standarized times for prophylactic anticoagulation was implemented to prevent patient "fall outs".

Results: Venous thromboembolism prophylaxis improved from 94 percent at baseline to 99 percent in the first quarter of 2012, and compliance with VTE prophylaxis assessment was improved in all patients. Antibiotic discontinuation prior to 24 hours of surgical end time improved from 94 percent to 99 percent and timely administration of antibiotic prior to surgery increased from 96 percent to 99 percent.

Conclusion: Quality indicators in SCIP patients have maintained and improved since the implementation of various pharmacy driven initiatives, demonstrating the direct impact of clinical pharmacy services on improving patient outcomes.