A clinical practice agreement between pharmacists and surgeons streamlines medication management.

Background: 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).

Methods: 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.

Results: 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).

Conclusion: 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.