Development and Implementation of a Ward‐Based Pharmacy Intervention for Dutch Surgical Patients

Medication errors can result in patient harm and additional hospital costs. Surgical patients are at risk of experiencing medication errors mainly due to multiple transfers between care providers at different locations in the hospital with associated medication changes, comorbidities and use of high-risk medicines. We evaluated a ward-based pharmacy intervention to overcome these risks. A strategy tailored to the surgical pathway and associated risks was developed from admission to discharge and implemented in 3 Dutch hospitals. A total of 547 surgical patients were assessed. 93% of patients had their medications reconciled on admission, 95% of patients had at least 1 medication review by the hospital pharmacist during their stay and 89% of patients had both. An intervention was recommended 880 times, mostly stopping, starting or altering medicines. The advice was accepted and actioned by the physician in 83% of cases. This pharmacy intervention provides a practical approach for ward-based medication reviews in surgical patients. Its cost-effectiveness remains to be proven.