Pharmacist involvement to improve patient outcomes in lower gastrointestinal surgery: a prospective before and after study.

Background Enhanced recovery pathways were first introduced in the UK in 2002 (Enhanced Recovery Partnership Programme in Delivering enhanced recovery-helping patients to get better sooner after surgery. Department of Health, London, 2010). The aims of such pathways are to reduce patient length of stay whilst still providing high quality of care. Objectives To evaluate the impact of pharmacist involvement in enhanced recovery pathways. Setting A large 1200 bed tertiary hospital in the North of England. Methods The pre-post study included all patients admitted for major colorectal surgery during the period 2013-2016. Baseline data were collected on all patients seen pre-operatively in a nurse-led pre-admission clinic. The intervention was introduced where a dedicated surgical pharmacist pre-operatively reviewed patients from the time they were listed for surgery until discharge with a focus on medicines optimisation. Main outcome measure The primary outcome measures were length of stay along with the type and number of post-operative complications. Results 100 patients were included in this study, with 50 patients in the baseline group and 50 patients in the intervention group. There was a significant reduction in the median length of stay (baseline group-10.5 days; intervention group-7.5 days; P < 0.001). The total number of complications was also less in the intervention group (baseline group-125; intervention group-75; P > 0.05) as was the number of patients whom had no complications (P > 0.05). Conclusions Active pharmacist involvement in enhanced recovery protocols is associated with a significantly reduced median length of stay as well as an overall reduction in the total number of post-operative complications.