4CPS-248 Integration of a clinical pharmacist into a general surgery team: results evaluation

Background The role of the hospital pharmacist has evolved in the last years and is becoming a more frequent presence in the medical teams, and is acquiring a fundamental role in pharmacotherapeutic decision-taking. Purpose To analyse the pharmaceutical interventions (IF) performed during 3 years in a general and digestive surgery unit (CGD) by a clinical pharmacist after integration into the team. Material and methods The pharmaceutical interventions performed in the general and digestive surgery unit were selected from the database (April 2014 to March 2017). The main activity was carried out with the coloprocto rectal surgery team participating in the daily checking visiting room with them, and the subsequent follow-up. For the evaluation of pharmaceutical interventions, an Excel tool has been developed, classifying them according to the Isofar ® program. Results 2,263 IF were performed, classified in nine items. In frequency order these were: initiation of treatment (782), nutritional adjustments (496), drug suspension (348), dose modification (193), drug change (129), modification of pharmaceutical form/administration route (116), confirmation of prescriptions (95), frequency modifications (77) and pharmacokinetic monitoring (27). Of the three most frequent items, regarding the start of treatment, 49% of the 782 IF were due to the need for additional treatment and 51% to non-prescribed home treatment. From the 496 IF of nutritional adjustments: 55.6% are due next to nutrition, 29.6% to adjustment of nutritional requirements, 7.4 to volume modifications, 3.7% to suspend nutrition and 3.7% to modify type of nutrition. Referring to the suspension of medication, from the 348 IF performed, the 40% correspond to therapeutic duplicity, 40% to excessive duration, 15% to non-indicated medicament and 5% to the prevention of adverse reactions. Conclusion The key points of the role of the clinical pharmacist in surgery are based on the IFs performed and the reconciliation of home medication and nutrition. The integration of the clinical pharmacist into the surgical care team is fundamental in the optimisation of pharmacotherapeutic treatment. References and/or Acknowledgements Acknowledgements to all the general surgery team No conflict of interest