薬剤師主導の緩和ケアパイロットプログラムにおける電子カルテツールの戦略的統合によるワークフロー効率の改善

Previous studies have shown that pharmacist involvement in inpatient palliative care programs is associated with lower daily cost expenditures and fewer patients with subsequent hospitalizations or urgent care visits. The objective of this study was to determine the impact of a new inpatient pain and palliative pharmacy service line staffed by a first year pharmacist resident. In this prospective, single center pilot study, a PGY1 pharmacy resident reviewed pain medications for hospitalized patients from February 3, 2025 through February 28, 2025, and joined with the interdisciplinary palliative care team attending daily huddle. The pharmacist resident reviewed 571 patients and made 79 interventions during the pilot duration (average 4.3 interventions per day). Most common intervention types included discontinuation of a medication, adding an adjunct medication, or dose adjustment. This study found that a dedicated pain and palliative care pharmacist resident integrated within the interdisciplinary palliative care team can make diverse interventions and recommendations to optimize pain and symptom management for hospitalized patients. Depending on the size of the medical center, the scope of such a position may need to be expanded to justify a full FTE pain and palliative pharmacist position.