A multifaceted intervention to reduce drug-related complications in surgical patients.
The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients.



A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward.



A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P = 0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention.



The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.
Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Jacqueline M
JM
Bos
Department of Clinical Pharmacy, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Patricia M L A
PM
van den Bemt
Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands.
Wietske
W
Kievit
Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands.
Johan L W
JL
Pot
Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands.
J Elsbeth
JE
Nagtegaal
Department of Clinical Pharmacy, Isala Hospital, Zwolle, the Netherlands.
André
A
Wieringa
Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, the Netherlands.
Monique M L
MM
van der Westerlaken
Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands.
Gert Jan
GJ
van der Wilt
Department Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands.
Peter A G M
PA
de Smet
Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.|Department of Clinical Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Cornelis
C
Kramers
D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D024382:Professional Role; D015397:Program Evaluation; D011446:Prospective Studies
medical education; medication errors; patient safety; prescribing
PLoS One. 2013 Aug 05;8(8):e71045
23940688
Int J Med Inform. 2014 Jun;83(6):406-15
24793784
Br J Clin Pharmacol. 2004 Apr;57(4):513-21
15025751
Neth J Med. 2013 Dec;71(10):502-7
24394734
Pharm World Sci. 2007 Feb;29(1):12-8
17268943
Ann Pharmacother. 2003 Feb;37(2):303-4; author reply 304-5
12549969
Qual Saf Health Care. 2003 Jun;12(3):194-200
12792009
JAMA. 1979 Aug 17;242(7):623-32
449002
Drug Saf. 2007;30(5):379-407
17472418
Drug Saf. 2010 Oct 1;33(10):853-64
20812770
Pharmacoepidemiol Drug Saf. 2012 Nov;21(11):1139-54
22761169
Arch Intern Med. 2008 Sep 22;168(17):1890-6
18809816
Br J Clin Pharmacol. 2012 Sep;74(3):411-23
22348303
Pharmacoepidemiol Drug Saf. 2007 Oct;16(10):1129-35
17610221
BMC Health Serv Res. 2013 Sep 28;13:364
24074346
Qual Saf Health Care. 2009 Feb;18(1):22-7
19204127
Drug Saf. 2014 May;37(5):317-32
24760475
Int J Clin Pharm. 2013 Oct;35(5):744-52
23722455
BMC Nephrol. 2014 Jan 06;15:2
24393347
Br J Clin Pharmacol. 2017 Mar;83(3):664-677
27670813
Eur J Clin Pharmacol. 2014 Jun;70(6):637-45
24671697
Int J Risk Saf Med. 2014;26(3):117-31
25214157
J Am Med Inform Assoc. 2009 Nov-Dec;16(6):816-25
19717798
J Am Med Inform Assoc. 2011 Nov-Dec;18(6):754-9
21676939
Ann Pharmacother. 2014 Oct;48(10):1298-312
25048794
Int J Qual Health Care. 2007 Oct;19(5):317-25
17599923
PLoS One. 2009;4(2):e4439
19209224
N Engl J Med. 2010 Nov 11;363(20):1928-37
21067384
Br J Clin Pharmacol. 2013 Dec;76(6):980-7
23627415
Syst Rev. 2014 Jun 04;3:56
24894078
Drug Saf. 2012 Mar 1;35(3):245-59
22339574
Drug Saf. 2011 Mar 1;34(3):233-42
21332247
Br J Surg. 2015 Sep;102(10):1204-12
26179814
Qual Saf Health Care. 2008 Aug;17(4):253-8
18678721
Pharm World Sci. 2008 Jan;30(1):31-8
17592752
J Am Med Inform Assoc. 2006 Mar-Apr;13(2):138-47
16357358
Am J Hematol. 2013 Jul;88(7):545-9
23553743
Br J Clin Pharmacol. 2008 Jul;66(1):128-34
18492128
PLoS One. 2014 Jan 03;9(1):e79802
24404122
Jt Comm J Qual Patient Saf. 2008 Apr;34(4):196-200
18468356
Educ Health (Abingdon). 2004 Nov;17(3):323-31
15848819
J Hosp Med. 2009 Feb;4(2):97-101
19219923
Eur J Clin Pharmacol. 2011 Jul;67(7):741-52
21318595
Hosp Pharm. 1992 Jun;27(6):538
10118597
J Nutr Health Aging. 2010 Jan;14(1):57-61
20082055
Qual Saf Health Care. 2008 Oct;17(5):360-3
18842975
Qual Saf Health Care. 2010 Dec;19(6):e26
20584702
QJM. 2015 May;108(5):369-77
25322990
Nucleic Acids Res. 2016 Jan 4;44(D1):D1054-68
26464438
J Am Med Inform Assoc. 2009 Sep-Oct;16(5):613-23
19567798
Am J Health Syst Pharm. 2007 Dec 1;64(23):2483-7
18029956