MeRIT Project: IMPROVE Part 2

Introduction:  Inappropriate withholding of chronic medications prior to surgery may lead to withdrawal symptoms, disease progression, or thrombosis. Failure to resume chronically prescribed medications after surgery increases 30 day mortality and the likelihood that a necessary medication remains unprescribed. The prospective evaluation of pharmacist-physician collaboration for perioperative medication reconciliation at the Internal Medicine PeRiOperatiVE (IMPROVE) Clinic pilot study was completed in Fall 2014; IMPROVE Part 2 will commence in Summer 2016.

Objectives: 1) Identify the sources of error in the medication list in the transitions of care for surgical patients. 2) Engage inpatient and outpatient providers to identify strategies to improve care transitions in the operative setting. 3) Implement a strategy to determine if errors in the medication list are reduced.

Study Design:  IMPROVE Part 2 is a prospective, single-arm, pre/post study.

Methods:  Adults scheduled for urologic surgery are eligible for enrollment. Medication reconciliation will occur pre-operatively, on admission, and within 24 hours of discharge, by an outpatient and an inpatient pharmacist. Data regarding medication discrepancies will be collected at each incidence of medication reconciliation.

Results: One hundred patients were enrolled in IMPROVE Part 1. At baseline, male gender (p=0.023), number of prescription medications (p=0.006), and number of OTC medications (p=0.000014) were significantly associated with errors on the pre-operative medication list. Thirty three patients completed IMPROVE Part 1; on average, there were 5.09 (+/- 3.71) errors on the pre-operative medication list and 3.69 (+/- 2.72) errors on the post-operative medication list (mean difference 1.39; 95% CI -0.2-3.04, p=0.09). Thirty percent of post-operative discrepancies had been corrected on the pre-operative list, yet persisted.

Conclusions:  In IMPROVE Part 2, it is expected that coordination between outpatient and inpatient pharmacists, and collaboration with physicians, will decrease the number of post-operative medication list discrepancies. Interprofessional communication will characterize the nature of such discrepancies.