Application and evaluation of a quality indicator system for pharmaceutical care in orthopedic perioperative pain...

This study aimed to implement a previously developed quality indicator system for pharmaceutical care in orthopedic perioperative pain management and evaluate its impact on adherence to pharmaceutical care standards.

A single-center before-and-after study with a historical control was conducted in 200 patients scheduled for elective orthopedic surgery. Pharmaceutical care quality was assessed using an established indicator system-developed in prior methodological work via the Delphi method and Analytic Hierarchy Process-in combination with the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). A retrospective pre-intervention cohort (n = 100, Nov 2024-Jan 2025) was evaluated to establish a reference, followed by targeted interventions. A prospective post-intervention cohort (n = 100, Apr-Jun 2025) was then evaluated. Groups were compared on overall adherence (Ci ≥ 0.6) to pharmaceutical care standards and full-score attainment rates of quality indicators. A sensitivity analysis was performed to assess the impact of documentation bias. Bonferroni correction was applied for multiple comparisons.

Overall adherence increased from 41% to 91% (risk difference, 50 percentage points; 95% CI, 37.83-60.05; P < 0.001), with a median difference of 0.32 (95% CI, 0.26-0.38). Sensitivity analysis confirmed the robustness of this finding: even under the most optimistic assumption for missing pre-intervention data, the post-intervention group remained higher (55% vs. 91%, P < 0.001). Four structural indicators showed descriptive improvements, with absolute increases ranging from 34 to 60 percentage points. Of the remaining 16 indicators, multimodal analgesia showed no significant difference (96% vs. 99%, P > 0.05). Among the other 15 process and outcome indicators, 13 remained significant after Bonferroni correction (α = 0.0031), with risk differences ranging from 14 to 33 percentage points. Two outcome indicators-achievement of target resting pain control and breakthrough pain incidence and management-did not reach the adjusted threshold, with improvements of 17 and 10 percentage points, respectively.

Implementation of a structured quality indicator system was associated with meaningful improvements in pharmaceutical care adherence in orthopedic perioperative pain management. Sensitivity analysis supported the robustness of the finding. Improvements were observed across structural (descriptive), process, and outcome indicators, with the majority of process and outcome indicators showing significant gains after conservative correction. Study limitations include the historical control design, reliance on a composite measure, and single-center setting. These findings provide empirical support and practical reference for implementing structured quality assessment to improve pharmaceutical care adherence.