The secret life of the surgical pharmacy in high risk periods

A pharmacy satellite dedicated to the operating room was implemented in 2020, including new dedicated rooms for emergency operations. Such an organisation requires continuity of care outside of working hours to maintain the quality and safety of patient care.

The aim of this work was to characterise this implementation through the prism of permanent care service, and to describe the activity of this particularly high risk period.

Prospective data collection was extracted from computerised on-call reports from March 2021 to March 2024. The primary endpoint was the proportion of shifts for continuity of pharmaceutical care affected by emergency operative room requests (considered as at higher risk), before (period 1, until December 2022) and after (period 2, from January 2023) the introduction of the new emergency rooms.

A total of 1109 pharmaceutical after hours shifts were carried out. During period 1, 24% of the shifts (n=156) were involved in at least one call from the operating room. A significant increase was recorded during period 2, involving 31% of pharmaceutical after-hours shifts (n=140) (p=0.012). Most requests were made between 18:00 and 24:00 and during the winter season (p=0.021). On average, two units of medical devices were needed by request (1-34) and most were re-sterilisable ones (61-75% of requests). Fifteen per cent of requests were urgent, with the patient already on the operating table, requiring a dispensing time of <1 hour. The average resolution time was 23 min and difficulties in responding to the demand were found in half of them, with potential impact on patients faced with emergency surgery.

This study allowed better characterisation of the surgical and pharmaceutical activity of a teaching hospital outside of working hours, enabling a better understanding of this period of high iatrogenic risk and reflection on areas for improvement.