Clinical Pharmacy Forum
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Service or Program: The multidisciplinary Brain Injury Center (BIC) clinic at our level 1 trauma center was established to provide a three-month follow-up for patients after traumatic brain injury (TBI). Patients received evaluation by a nurse, trauma nurse practitioner, and speech language pathologist. Given the complex medication needs following TBI, a clinical pharmacist visit was added to BIC services in 2019. The pharmacist interviewed patients in weekly BIC clinic with the team and documented activities using an intervention documentation system with a pharmacotherapy consultation note in the electronic medical record. The pharmacist collected and documented the current medications, TBI symptoms, counseling points, and medication recommendations in the pharmacotherapy consultation note. This information was also communicated verbally to the team.
Justification/Documentation: Patients who received clinical pharmacy services in BIC clinic between January 2020 and August 2022 were reviewed. The number and types of interventions, as well as medications involved were obtained by chart review. 399 patients received pharmacy services during a total of 461 clinic visits. The average number of interventions per patient and per visit was 2.7 interventions (± 1.4). A formal medication reconciliation was documented in 97% of patients.
Adaptability: All clinic patients had a history of TBI, and the average initial Abbreviated Injury Scale Head was 3 (± 0.9). Pharmacy services were provided by a critical care clinical pharmacist, pharmacy fellows, and supervised student pharmacists.
Significance: Medication discontinuation was recommended for 39 drugs, and 47 new prescriptions were started. Thirty-one dosage adjustments were made. OTC medications were recommended in 175 instances, and 501 medications required counseling. The most common drug classes involved in pharmacist services included non-opioid analgesics (155 visits). Other common drug classes included antiseizure medications, natural sleep aids, and antidepressants. The pharmacist provided consistent medication reconciliation, medication education, OTC medication assistance, and prescription recommendations in this unique practice setting.
Presenting Author
Susan Hamblin PharmD, BCCCP, FCCMLipscomb University College of Pharmacy
Authors
Leanne Atchison Pharm.D.
Vanderbilt University Medical Center
Jennifer Beavers Pharm.D., BCPS
Vanderbilt University Medical Center
Bradley Dennis MD, FACS
Vanderbilt University Medical Center
Landry Slaughter PharmD Candidate
Lipscomb University College of Pharmacy
Candice Smith MSN, RN, CCRN-K
Vanderbilt University Medical Center