4CPS-074 Optimising medication safety: the role of pharmacist-led interventions in reducing drug related problems in geriatric vascular surgery patients

<h3>Background and Importance</h3> Peripheral artery disease is a common condition, particularly in geriatric populations with comorbidities such as hypertension, dyslipidaemia, or diabetes. These patients are at an elevated risk of cardiovascular morbidity and mortality, and frequently experience polypharmacy, which increases the likelihood of drug related problems (DRPs) and treatment failure. <h3>Aim and Objectives</h3> This study, a subanalysis of a previous investigation, aimed to evaluate the impact of pharmacist-led interventions on the prevalence of DRPs in geriatric patients undergoing vascular surgery. <h3>Material and Methods</h3> This study, a subanalysis of a previous study conducted on adult patients, focused specifically on geriatric patients (≥ 65 years old) diagnosed with carotid artery disease or lower extremity artery disease, all of whom were prescribed at least three medications. Comprehensive medication reconciliation and medication reviews were conducted by hospital pharmacists at both admission and discharge. Pharmacist-recommended interventions were documented and communicated to the attending physicians. Patients were provided with individualised pharmacotherapy education upon discharge to enhance medication adherence and understanding. <h3>Results</h3> The study cohort included 80 geriatric patients, with a significant decrease in the mean number of DRPs per patient, from 2.26 ± 2.12 at admission to 1.51 ± 1.87 at discharge (p &lt; 0.001). The most common DRPs involved untreated symptoms or indications. Naftidrofuryl, considered a potentially inappropriate medication for older adults per the EU (7)-PIM list, was used by 50% of patients at both admission and discharge. Cardiovascular drugs contributed to 26.91% of DRPs, with atorvastatin (for untreated indications) most implicated at admission, and pantoprazole (unnecessary treatment) at discharge. Physicians accepted 57.9% of pharmacist-recommended interventions. A standardised DRP severity scale was not used due to the novelty of pharmacist-led DRP identification in our setting, limited physician familiarity with such recommendations, and their high workload, all of which impacted acceptance rates. Nearly half of the patients showed a good understanding of their pharmacotherapy at admission. <h3>Conclusion and Relevance</h3> Pharmacist-led interventions were associated with a significant reduction in DRPs among vascular surgery patients. This underscores the critical role of pharmacists in optimising medication management, improving therapeutic outcomes, and reducing the risk of medication related complications in this high-risk population. <h3>References and/or Acknowledgements</h3> https://pubmed.ncbi.nlm.nih.gov/36862371/ https://pubmed.ncbi.nlm.nih.gov/31157072/ https://pubmed.ncbi.nlm.nih.gov/24796911/ https://pubmed.ncbi.nlm.nih.gov/31156996/ https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf <h3>Conflict of Interest</h3> No conflict of interest