title: Quality of pharmaceutical care in surgical patients.
abstract: BACKGROUND
  Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements.
  
  
  OBJECTIVE
  To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements.
  
  
  METHODS
  For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients.
  
  
  RESULTS
  Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and 'sensitivity to change'. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%).
  
  
  CONCLUSIONS
  This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.
authors.affiliation: Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Monica
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Maya A
authors.initials: MA
authors.lastname: Ramrattan
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Eveline B
authors.initials: EB
authors.lastname: Boeker
authors.affiliation: Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Paul F M
authors.initials: PF
authors.lastname: Kuks
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: Department of Hospital Pharmacy, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Loraine
authors.initials: L
authors.lastname: Lie-A-Huen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007297:Inpatients; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000592:standards*; D019984:Quality Indicators, Health Care; D055815:Young Adult
chemical_list: D000700:Analgesics