Impact of a pharmacist-led elective caesarean section pre-admission clinic on efficiency of pharmacist workflow and patient preparedness for post-operative discharge medication supply: a retrospective observational study.

Abstract

Introduction: Rapid patient throughput on maternity wards results in pharmacist resources being directed towards discharge processes, primarily focused on patients who have undergone caesarean section (CS) due to their discharge medication requirements. This occurs at the expense of admission processes, including best possible medication history (BPMH) documentation.

Aim: To evaluate the impact of a pharmacist-led elective caesarean section (ELCS) pre-admission clinic (PAC) on efficiency of pharmacist workflows, BPMH documentation, and patient preparedness for analgesic supply on discharge.

Method: A retrospective observational study was undertaken at an Australian tertiary obstetric public hospital where an ELCS PAC was introduced through reallocation of clinical pharmacist resources. The PAC pharmacist attempted telephone contact with all patients scheduled for ELCS, within 1 week before surgery. The pharmacist obtained and documented a BPMH, and where appropriate, encouraged patients to purchase paracetamol and ibuprofen pre-operatively. Data were collected from electronic medical records and dispensing records for 1 month pre- and 2 months post-implementation, including: CS classification (elective or emergency); whether PAC was completed and timing of completion before CS; number of BPMH documented per day; timing of BPMH completion after CS; pharmacist staffing levels; and whether paracetamol and ibuprofen were dispensed on discharge.

Results: During the 3-month study period, 1863 patients were admitted to the maternity wards, with 654 patients birthing via CS. Elective CS accounted for 43.3% (283/654) of CS deliveries, with 57.2% (162/283) of these patients reviewed in ELCS PAC. Post-implementation, workflow efficiency increased, with 19.9% more BPMH documented per pharmacist per day (3.87 vs 4.64, p = 0.012). Overall BPMH completion increased for all patients who underwent CS (83.7% vs 93.3%, p < 0.001). Timeliness of BPMH documentation improved for ELCS patients, with higher BPMH completion on the day of surgery (19.8% vs 34.5%, p = 0.019). Patients reviewed in PAC were less likely to require discharge supply of paracetamol (52% vs 37.1%, p = 0.031) and ibuprofen (80% vs 56.4%, p < 0.001).

Conclusion: Reallocation of resources to introduce the ELCS PAC enhanced workflow efficiency and BPMH completion. Patient preparedness improved, with reduced reliance on hospital supply of simple analgesics on discharge.