Electronic pharmaceutical record for best possible medication history at preoperative evaluation to prevent postoperative adverse events: a quasi-experimental study.

Abstract

Background: Access to reliable data about patient's medications before surgery represents a challenge for reducing the risk of postoperative adverse events (AE) potentially related to preoperative treatment.

Objective: To evaluate the impact on AE of a nationwide ambulatory electronic pharmaceutical record (EPR) used by a pharmacist for best possible medication history (BPMH), associated with the preoperative evaluation.

Methods: This quasi-experimental comparative interventional study included 750 adult patients with an available EPR, admitted to the preoperative clinic for elective orthopaedic surgery, between April 2014 and April 2017. Data analysis was completed in September 2022. In the intervention group, a pharmacist performed the BPMH using the EPR, before the patient's medical evaluation. In the control group, there was conventional preoperative evaluation. The primary outcome was the number of patients with at least one AE collected by using the trigger tool method, within 30 days after surgery. Secondary outcomes were the number of medications reported in the medical record and the number of patients with at least one documented adverse drug event (ADE) by an independent committee within 30 days after surgery.

Results: Of 1924 patients admitted to the preoperative clinic, 750 patients who had a record (39%) were included (153 (41%) men; median age 61 (49-71 and 50-70) years in both groups), 375 in each group. There was a 29% reduction in the proportion of patients with at least one AE in the intervention group (110/374 patients (29%) with 165 AE vs 156/372 patients (42%) with 233 AE) (OR 0.58 (0.43-0.78), p<0.01). There were significantly more drugs reported on the medical record in the intervention group (3 (1-5) vs 2 (1-4), p<0.01). There was no significant difference between the two groups in the number of patients with ADE (71/374 patients (19%) with 96 ADE vs 80/372 patients (22%) with 108 ADE, p=0.44).

Conclusions and relevance: A BPMH performed by a pharmacist using a nationwide EPR at the time of preoperative evaluation contributed to reducing AE, potentially preventing harm to patients.

Trial registration number: NCT02071472.