Answer:

An operating-room (OR) pharmacist is a great asset to the perioperative team. The establishment of nurse-pharmacist teams in the perioperative area can reduce the incidence of adverse drug events because the pharmacist can review ORDERS prior to administration. OR pharmacists can have a significant effect on hospital compliance with Surgical Care Improvement Project measures. Several regulatory compliance processes can be monitored and addressed daily by OR pharmacists. Initiating new processes and standardizing ANESTHESIA drug trays can decrease medication errors, improve organization of anesthesia medications, and encourage safe injection practices. A key role of the OR pharmacist is to manage narcotic dispensing and reconciliation processes that inhibit drug diversion. Inclusion of a pharmacist on the multidisciplinary OR team should be standard practice in all hospitals.

Given the complexities of current surgery processes, the presence of a pharmacist on the multidisciplinary team is vital to the overall success of the perioperative period. Operating-room (OR) pharmacists assist daily with medication dosing, selection, and dispensing; compounded sterile preparations; Surgical Care Improvement Project (SCIP) guideline compliance; cost-containment practices; narcotic dispensing and diversion methods; pharmaceutical waste disposal; and regulatory compliance. See TABLE 1 for useful online resources.

Benefits of Pharmacist Collaboration

The use of nurse-pharmacist teams has been reported to prevent adverse drug events during the medication-reconciliation process upon hospital admission and discharge.1 The same type of collaboration is beneficial in the perioperative period. As a member of the first-line multidisciplinary team, the pharmacist can relieve the nursing staff of some responsibilities by reviewing preoperative medications prior to administration for appropriate selection (specifically, SCIP procedures); drug allergies; drug-drug interactions; and weight-based, renal, or hepatic dosage adjustments.

The author of this article has noted, at her hospital, the increased frequency of surgeons employing order sets meant to cover all patients undergoing a particular procedure. Although there may be advantages to this method of prescribing, what gets left out of the equation is individualized care for each patient. The most common PROBLEM is allergy to medications in the SURGEON’s preoperative orders. This is a key opportunity for the pharmacist to intervene and suggest alternative medications, thereby expediting the patient’s surgical-preparation procedures.

The prevalence of documented beta-lactam allergy is notable, constituting a minimum of 10% of all self-reported allergies.2 This author has found this to be one reason that antibiotics are not stocked in automated dispensing cabinets in outpatient or inpatient holding areas in her hospital. This hospital has MADE it a priority that all preoperative antibiotic orders be reviewed by a pharmacist and entered into the electronic medication-administration record (eMAR) prior to administration. This allows the pharmacist to screen for possible drug-drug interactions or necessary dosage adjustments and review the patient’s documented allergy list.

Frequently, patients reporting an antibiotic allergy are prescribed alternative antibiotics that are less effective, cover a larger scope of antimicrobials, or cost more than the first-line agent.3 When a pharmacist has the opportunity to evaluate a patient’s self-reported allergies, he or she can determine whether the reaction is a true allergy or a possible side effect. This intervention can obviate the need to switch the initial antibiotic of choice to a more costly or less effective alternative.

SCIP Compliance Measures

The OR pharmacist can play a large role in some SCIP compliance measures. SCIP is a nationally recognized effort by several organizations that have collaborated to help minimize complications associated with certain surgical procedures.4 The Centers for Medicare and Medicaid Services and The Joint Commission (TJC) use SCIP guidelines to evaluate hospitals’ achievements with regard to surgery patients.4

The OR pharmacist can make an impact on three main SCIP measures: SCIP-inf-1, SCIP-inf-2, and SCIP-inf-3. These measures are described thusly in TJC’s 2014 Specification Manual for National Hospital Inpatient Quality Measures: SCIP-inf-1, Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision; SCIP-inf-2, Prophylactic Antibiotic Selection for Surgical Patients; and SCIP-inf-3, Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time.5 The OR pharmacist can influence hospital compliance with these measures.