Effect of a ward-based pharmacy team on preventable adverse drug events in surgical patients (SUREPILL study).

Abstract

Surgical patients are at risk of adverse drug events (ADEs) causing morbidity and mortality. Much harm is preventable. Ward-based pharmacy interventions to reduce medication-related harm have not been evaluated in surgical patients. This multicentre prospective clinical trial evaluated a protocolled, ward-based pharmacy method compared with standard pharmaceutical care in surgical patients. Allocation of study group was done by one-time randomization at ward level. Consecutive patients admitted for elective surgery with an expected hospital stay longer than 48 h were included. Pharmacy practitioners performed bedside medication reconciliation at admission and discharge, and hospital pharmacists undertook regular medication reviews in the study wards. Preventable ADEs and clinical outcomes were assessed. A total of 1094 surgical patients were studied. Some 880 specific interventions were made by the hospital pharmacist to improve pharmacotherapy in 309 of 547 patients on study wards. A further 547 patients were included on control wards. A crude non-significant reduction in incidence of preventable ADEs was seen on intervention wards in comparison with control wards (2.74 versus 3.84 preventable ADEs per 100 admissions; incidence rate ratio 0.71, 95 per cent c.i. 0.37 to 1.39; P = 0.324). After adjustment for differences in treatment groups and for potential confounding, the incidence rate ratio remained non-significant (0.82, 0.39 to 1.72; P = 0.598). No differences were seen for other outcomes, such as duration of hospital stay, number of complications and quality of life. The present prospective controlled trial showed no significant reduction in medication-related harm or changes in clinical outcomes when surgical patients received protocolled ward-based pharmacy interventions.