Saudi Cultural Missions Theses & Dissertations
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Item Restricted Evaluating the Impact of Pharmacist Interventions for High-Risk Patients within a Preoperative Assessment Clinic(Saudi Digital Library, 2025) Aljehani, Yousuf; Suthakaran, Sharanyhan; Bates, Ian; Garfield, SaraBackground: Pharmacists contribute to surgical pathways by optimising high-risk medicines and supporting safe care. While their involvement is recognised, the nature of their specific interventions in surgical settings is not well documented. Aim: To evaluate the impact of pharmacist interventions on the prevention of potential medication-related issues (pMRIs) in surgical patients prescribed high-risk medicines. Methods: A mixed-methods retrospective study design was conducted at a specialist London teaching hospital. A total of 297 referrals were reviewed, with 176 included. Pharmacist actions were categorised using a custom tool to model pMRIs in the absence of intervention. Severity and likelihood were assessed with the SCATH and LORE tools. An expert panel independently rated 18 anonymised cases. Two case exemplars illustrated clinical decision-making. Results: Referrals mainly involved anticoagulants (38.1%), antiplatelets (21.6%), antidiabetics (19.9%), and immunosuppressants (23.9%). A total of 306 interventions were made, including continuation (44.4%), withholding (39.2%), bridging (11.1%), and dose adjustment (5.2%). CFL identified bleeding (n=49), autoimmune exacerbation (n=40), and thrombosis (n=38) as common pMRIs. Severity was disproportionately higher for thrombotic/bleeding events (χ²(4, N=302)=74.9, p<0.001), while likelihood was more often rated likely for these events (χ²(4, N=302)=138.1, p<0.001). Panel agreement was significant for likelihood (W=0.237, p=0.005) but not for severity or intervention appropriateness. Conclusion: Pharmacists in this surgical setting are likely to mitigate severe medication-related harms, particularly thrombotic and bleeding events. Broader referral criteria, systematic documentation, and comparative designs are needed to strengthen evidence of their impact.20 0