Reducing medication errors in neurosurgery through clinical pharmacy interventions: a prospective observational...

Area of Science:

• Neurosurgery
• Clinical Pharmacy
• Patient Safety

Background:

• Neurosurgical care is complex, with high rates of polypharmacy, elderly patients, and comorbidities, increasing medication error risks.
• Dynamic treatment plans and intensive care needs further complicate medication management in neurosurgery.

Purpose of the Study:

• To evaluate the impact of a structured, weekly pharmacist-led medication review program on prescribing practices and patient outcomes in a neurosurgical department.
• To assess the effectiveness of pharmacist interventions in enhancing medication safety and improving clinical results within this high-risk patient population.

Main Methods:

• A 12-month prospective study involving weekly medication reviews by a clinical pharmacist on a neurosurgical ward and high-dependency unit (HDU).
• Interventions were documented, with 10% re-audited for uptake. Data from the intervention year were compared to historical controls for length of stay (LOS) and in-hospital mortality.
• The study period was divided into two six-month epochs to analyze temporal trends in intervention rates.

Main Results:

• A total of 996 interventions were documented for 1795 patients (0.55 interventions/patient).
• Median LOS decreased from 8.1 to 7.3 days (p=0.032), prolonged hospitalizations (>14 days) fell from 18.9% to 14.8% (p=0.002), and in-hospital mortality declined from 4.6% to 3.0% (p=0.014).
• Intervention rates showed a learning effect, declining from 0.7 to 0.4 per patient between epochs (p=0.016), with 78% implementation of recommendations.

Conclusions:

• Routine integration of clinical pharmacists into neurosurgical care significantly reduces medication-related issues.
• The program demonstrated measurable improvements in LOS and mortality, supporting pharmacist-led interventions in high-risk surgical environments.
• Further controlled multicenter trials are warranted to validate these findings and support broader implementation.