| Purpose:To establish a perioperative pharmaceutical monitoring mode for cardiac surgery based on medication reconciliation.Method:We analyzed perioperative data of 106 patients who received warfarin after cardiac valve replacement retrospectively,which turned to be unsatisfactory.We further investigated 448 patients undergoing cardiac surgery for their underlying disease,perioperative medication and clinical data retrospectively and developed perioperative pharmaceutical care procedures based on medication reconciliation.Finally,we follow up patients with our perioperative pharmaceutical monitoring mode prospectively and provide proper pharmaceutical care warfarin anticoagulant therapy by clinical pharmacist.Results:During 2016 and 2017,patients who took warfarin after cardiac surgery reaching target INR on average(7.11 ± 3.19)days after surgery,and the INR compliance time percentage during the postoperative period was(26.99 ± 17.24)%,the INR compliance rate at discharge was 53.77%.The postoperative hospital stay was(15.73±7.26)days.There were 20 categories of drugs used in patients with cardiac surgery due to underlying diseases,and the perioperative checkpoints for the 6 most common categories are reviewed.With our perioperative pharmaceutical monitoring,the time of reaching target INR was(6.11 ±2.19)days,the INR compliance time was(39.18±17.75)%and the INR compliance rate at discharge was 77.36%,they were significantly improved.The postoperative hospital stay was(12.57±3.68)days,it's also shortened.Conclusion:The beginning quality of warfarin anticoagulant therapy in our hospital were poor.Based on medication reconciliation services,the perioperative pharmaceutical monitoring mode could effectively identify and correct drug deviations and improve patient safety.With a adjusted model of warfarin anticoagulant therapy pharmacy service can effectively improve patient compliance and improve the quality of perioperative warfarin anticoagulant therapy. |
PDF Full Text Request