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

Abstract

Neurosurgical patient care is inherently complex, characterized by high rates of polypharmacy, advanced age, and significant comorbidities, all of which increase the risk of medication errors. These challenges are compounded by dynamic treatment plans and intensive care demands. In response, clinical pharmacist-led "pharmaceutical interventions" have emerged as a promising strategy to enhance medication safety. This study aimed to evaluate the impact of a structured weekly pharmacist-led medication review programme on prescribing practices and patient outcomes in a tertiary academic neurosurgical department. In this 12-month prospective study, a pharmacist performed weekly medication reviews on the neurosurgical ward and HDU. Interventions were coded in ADKA-DokuPIK and relayed to the team; 10% were re-audited to confirm uptake. The year was split into two six-month epochs to assess temporal trends. Administrative data from the intervention year were compared with a historical control for length of stay (LOS) and in-hospital mortality. Adverse-drug-event rates were not prospectively collected. A total of 996 interventions were documented among 1795 patients (0.55/patient). Intervention rates declined from 0.7 to 0.4 per patient between periods (p = 0.016), suggesting a learning effect. Implementation of recommendations was confirmed in 78% of audited cases. The most commonly affected drugs were pantoprazole (n = 77), amlodipine (n = 47), ciprofloxacin (n = 44). Median LOS decreased from 8.1 to 7.3 days (p = 0.032), the proportion of prolonged hospitalisations (> 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). Routine integration of a clinical pharmacist into neurosurgical care was associated with fewer medication-related issues, measurable improvements in LOS and mortality, and evidence of progressive prescriber adaptation. These findings support broader implementation of pharmacist-led interventions in high-risk surgical environments. Controlled multicenter trials are warranted.