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4CPS-240 Adding value: pharmacist interventions in the perioperative setting
  1. A Ribed1,
  2. A Gimenez-Manzorro1,
  3. A de Lorenzo1,
  4. J Zorrila2,
  5. C Ortega1,
  6. A Herranz-Alonso1,
  7. M Sanjurjo1
  1. 1Hospital General Universitario Gregorio Marañon, Pharmacy, Madrid, Spain
  2. 2Hospital General Universitario Gregorio Marañon, Surgery, Madrid, Spain


Background Surgery complications are a hospital quality indicator.

Purpose The aim is to describe the interventions in a perioperative pharmaceutical care programme and health outcomes in abdominal surgery patients.

Material and methods The comprehensive care programme was implemented in August 2016. Pharmacists’ clinical interviews took place 2 weeks prior to surgery: to revise and deliver carbohydrated drinks, thromboembolic prophylaxis and intestinal preparation accompanied by written information; to document the complete medication list including OTC and herbal products and medication reconciliation; and to evaluate patient understanding about correct administration of chronic drugs and to make new recommendations, if necessary and to document all information in the patients’ medical records.

An observational prospective study was carried out. Patients attending the pharmaceutical consultation from August 2016 to August 2017 were included. The primary outcome was pharmacists’ interventions classified according to Overhage classification and the severity of medication errors according to NCC MERP.

Results One hundred and twenty-two patients were included, mean age 69.2 years, 59.8% males, 58.2% undergoing colon and 41.8% rectal surgery. Nine patients were on anticoagulants, 17 were taking antiplatelet drugs and 19 herbal products.

In 65 patients there were chronic drugs that should be modified prior surgery. Eighty one pharmacist interventions were recorded: 16 addressed to surgeons (19.7%), 27 to anaesthetists (33.3%) and 38 to patients (46.9%). Interventions were classified as inappropriate drug prior to surgery (n=54), patient misunderstanding (n=15), drug omission (n=4), duplication (n=4), wrong dose (n=3) and wrong drug administration (n=1). Examples include: inadequate prescription of intestinal preparation or carbohydrate drinks; wrong dose of thromboembolic prophylaxis; non-suspension of antihypertensive drugs prior to surgery; and information reinforcement to patients. The anticoagulant treatment was modified in two patients, whereas three anticoagulant patients had misunderstood the recommendations.

According to the severity of medication errors, 77 (95.1%) errors were serious D/E/F, and four (4.9%) classified as error without harm (C).

Regarding health outcomes, one surgery suspension was recorded due to wrong perioperative medication management. The mean length of hospital stay was 5 days (3–8). The readmission rate at 30 days was 16.4% (n=20).

Conclusion The perioperative pharmaceutical care programme was successfully implemented. Pharmacist interventions avoided serious errors and improved chronic drug management prior to surgery. Only one surgery in a year period was suspended due to wrong perioperative medication management.

No conflict of interest

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