A clinical practice agreement between pharmacists and surgeons streamlines medication management

Collaborative practice agreements (CPAs), which have been widely used in ambulatory care, were applied to hospital surgical teams in a postsurgical colorectal surgery unit at Mayo Clinic Rochester (Minnesota).

The CPA allowed pharmacists the decision rights to initiate, modify, or discontinue medications in accordance with the surgical teams' practice standards, evidence-based medicine, and/or institutional policies without specific request and response from the surgeon/provider. Interventions for CPA and non-CPA groups were captured from a prospectively maintained database. Admission medication reconciliation (patient medication list compared with hospital orders) was compared between CPA patients and non-CPA patients. Time-to-decision and surgical service interruptions were measured by an audit of 50 CPA interventions versus 50 non-CPA interventions.

For the 135 CPA-eligible colorectal and general surgery patients in January-March 2011, there were 417 pharmacist interventions (3.1 per patient episode), compared with 537 for 305 non-CPA patients on a comparable surgical unit (1.8 per patient episode) (p < or = .0200). Admission medication reconciliation was completed for 135/135 (100%) of CPA patients versus 220/305 (72%) of non-CPA patients (p < or = .001). Rules-based interventions with CPA totaled 21/417 (5%) versus 221/537 (41%) without CPA (p < or = .0001). The time-to-decision (CPA versus non-CPA) was within 1 minute versus 0 to 4,320 minutes (mean, 314.2 minutes; median, 138 minutes), respectively (p = .0063).

The CPA increased pharmacist interventions and increased both accuracy and efficiency in resolving medication-related problems. The CPA streamlined and improved medication management of hospitalized surgical patients.