{
  "abstract": "Background and Importance Patients undergoing cardiac surgery frequently present with multiple comorbidities. Given their average age of 66 years and the fact that they are prescribed numerous concomitant medications, they are consequently at heightened risk of adverse drug reactions.Aim and Objectives The primary objective was to enhance the safety of pharmacotherapy by resolving drug-related problems. The secondary objective was to identify the most frequent and effective interventions undertaken by clinical pharmacists in the Cardiac Surgery Department.Material and Methods Two clinical pharmacists conducted medication reviews over a six-month period (from 1.03.2025 to 31.08.2025) for 322 patients in the Cardiac Surgery Department.All identified drug-related problems were classified according to the PCNE (Pharmaceutical Care Network Europe) system. Recommended interventions were discussed directly with cardiac surgeons and, if accepted, implemented.The pharmacists also delivered 12 training sessions to the cardiac surgery team. The level of satisfaction with the collaboration between the cardiac surgery team and the pharmacists was assessed using a survey.Results A total of 268 interventions were made for 113 patients. 209 patients needed no intervention. Deprescribing was one of the most effective interventions, accounting for 40% of all interventions (106 in total) and resulting in a reduced medication list for 66 patients. Additionally, 11% of all interventions involved medication substitution (i.e. deprescribing and prescribing a more suitable medication).The three most frequently deprescribed medication groups were as follows:Hypnotics and anxiolytics (particularly benzodiazepines and non–benzodiazepine „Z–drugs’) – 25% (27 interventions)Antihypertensives – 12% (13 interventions)Antibiotics – 9% (10 interventions)27% (n=29) of deprescribing interventions were related to duplication of therapeutic groups or active ingredients, or to the use of unnecessary drugs for the same indication.88% (n=93) of deprescribing interventions were accepted and implemented.88% (n=7) of the cardiac surgery team members assessed the influence of clinical pharmacists on improving the quality of pharmacotherapy as very positive or positive.Conclusion and Relevance Integrating clinical pharmacists into the healthcare team can significantly improve pharmacotherapy for cardiac surgery patients, particularly by supporting effective deprescribing. The findings may be applied in other surgical departments to help improve the safety and effectiveness of pharmacotherapy.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "The Medicover Hospital, Hospital Pharmacy Department, Warsaw, Poland"
      ],
      "name": "M Lopata"
    },
    {
      "affiliations": [
        "Medicover Hospital, Hospital Pharmacy Department, Warsaw, Poland"
      ],
      "name": "M Nawłoka"
    },
    {
      "affiliations": [
        "Medicover Hospital, Cardiac Surgery Department, Warsaw, Poland"
      ],
      "name": "K Wróbel"
    }
  ],
  "title": "4CPS-332 Less is more – deprescribing in the cardiac surgery department",
  "uid": "de913229-19d2-5cf3-893c-e2cf4b41952a"
}