Pharmacist consultations in hospitalised older surgical patients

Older adults are at high risk of drug-related problems during hospitalisation for surgery. Pharmacists play a key role in the multidisciplinary health care team to improve the safety and quality use of medicines in hospitals. The aims of this prospective study were to examine the frequency, type, associated factors, and acceptance rates of pharmacist consultations in a cohort of 302 consecutive patients aged ≥65 years admitted to a tertiary vascular surgery unit. Data collected included frequency and type of pharmacist consultations, patient and clinical characteristics, and the rate of acceptance of pharmacist recommendations. There was a total of 299 pharmacist consultations, with 159 (52.6%) patients being reviewed at least once by a pharmacist. Of the 299 pharmacist consultations, the most common reason for consultation was a medication order review (38.8%). Pharmacist consultation was more likely if the patient had an emergency admission (p = 0.045), had admission to intensive care unit during the hospitalisation (p < 0.001), or had a long-stay admission defined as >14 days (p < 0.001). Older age, frailty status, cognitive impairment, polypharmacy, and operative management were not associated with having a pharmacist review. Of these pharmacist consultations, 190 (63.5%) included recommendations for the care team to implement, and 166 (87.4%) of the 190 recommendations were addressed. These findings provide insight into the roles played by hospital pharmacists and suggest an unmet need for proactive pharmacist consultation for older surgical patients with polypharmacy, frailty, and cognitive impairment. Ethical approval was granted by the Sydney Local Health District Human Research Ethics Committee — Concord Hospital (Reference no: CH62/6/2018–170) and the study conforms to the Australian National statement on ethical conduct in human research.