title: Integration of a Clinical Pharmacist into an Interdisciplinary Palliative Care Outpatient Clinic.
abstract: OBJECTIVE
  The primary objective of this quality improvement (QI) project was to determine if the Interdisciplinary Palliative Care Outpatient Clinic (IPCOC) at the West Palm Beach Veterans Affairs Medical Center offered improved symptom assessment and palliative care treatment outcomes. Secondary objectives were to identify, classify, and resolve medication problems and calculate the number of pharmacist recommendations accepted by prescribing providers.
  
  
  METHODS
  An IPCOC was created by selecting disciplines for a core group including a nurse practitioner, clinical pharmacist, social worker, chaplain, and physician. Consult referrals were recruited by providing educational sessions. The patient assessments were completed using the Edmonton Symptom Assessment System: (revised version; ESAS-R). The clinical pharmacist classified and resolved drug-related problems. The pharmacy resident telephoned veterans for completion of the "Patient Assessment: Overall Satisfaction with Outpatient Palliative Care Clinic."
  
  
  RESULTS
  Seventeen consults were received, 6 patients were excluded, and 11 were seen in clinic. One (9%) of 11 patients met the outcomes measure of system assessment documentation in the past year. At completion, 11 (100%) of 11 patients met the outcomes data measure. The Patient Satisfaction Assessment revealed veterans strongly agree to recommend the IPCOC. The clinical pharmacist identified 20 drug-related problems, made 16 recommendations, had a 93.7% implementation rate, and facilitated implementation of medication changes.
  
  
  CONCLUSIONS
  This QI project demonstrates that an IPCOC improved symptom assessment and palliative care outcomes in addition to resolution of medication prescribing issues in veterans with advanced cancer by integration of a clinical pharmacist into the core team.
authors.affiliation: 1 Department of Pharmacy Service (119), West Palm Beach Veterans Affairs Medical Center, Riviera Beach, FL, USA.
authors.forename: Sandra Lee
authors.initials: SL
authors.lastname: DiScala
authors.affiliation: 1 Department of Pharmacy Service (119), West Palm Beach Veterans Affairs Medical Center, Riviera Beach, FL, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Onofrio
authors.affiliation: 1 Department of Pharmacy Service (119), West Palm Beach Veterans Affairs Medical Center, Riviera Beach, FL, USA.
authors.forename: Maura
authors.initials: M
authors.lastname: Miller
authors.affiliation: 1 Department of Pharmacy Service (119), West Palm Beach Veterans Affairs Medical Center, Riviera Beach, FL, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Nazario
authors.affiliation: 1 Department of Pharmacy Service (119), West Palm Beach Veterans Affairs Medical Center, Riviera Beach, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Silverman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D010595:Pharmacists / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: ESAS-R; Edmonton Symptom Assessment System: (revised version); interdisciplinary team; outpatient clinic; palliative care; palliative clinic; pharmacist; pharmacists