International Journal of Clinical Pharmacy

, Volume 36, Issue 3, pp 581–588 | Cite as

Evidence based development of bedside clinical drug rules for surgical patients

  • Maya A. RamrattanEmail author
  • Eveline B. Boeker
  • Kim Ram
  • Desiree M. T. Burgers
  • Monica de Boer
  • Loraine Lie-A-Huen
  • Wilhelmina M. C. Mulder
  • Marja A. Boermeester
Research Article


Background Surgical adverse events constitute a considerable problem. More than half of in-hospital adverse events are related to a surgical procedure. Medication related events are frequent and partly preventable. Due to the complexity and multidisciplinary nature of the surgical process, patients are at risk for drug related problems. Consistent drug management throughout the process is needed. Objective The aim of this study was to develop an evidence—based bedside tool for drug management decisions during the pre- and postoperative phase of the surgical pathway. Setting Tool development study performed in an academic medical centre in the Netherlands involving an expert panel consisting of a surgeon, a clinical pharmacist and a pharmacologist, all experienced in quality improvement. Method Relevant medication related problems and critical pharmacotherapeutic decision steps in the surgical process were identified and prioritised by a team of experts. The final selection comprised undesirable effects or unintended outcomes related to surgery (e.g. pain, infection) and comorbidity related hazards (e.g. diabetes, cardiovascular diseases). To guide patient management, a list of bedside surgical drug rules was developed using international evidence-based guidelines. Main outcome measure 55 bedside drug rules on 6 drug categories, specifically important for surgical practice, were developed: pain, respiration, infection, diabetes, cardiovascular diseases and anticoagulation. Results A total of 29 evidence—based guidelines were used to develop the Bedside Surgical Drug Rules tool. This tool consist of practical tables covering management regarding (1) the most commonly used drug categories during surgery, (2) comorbidities that require dosing adjustments and, (3) contra-indicated drugs in the perioperative period. Conclusion An evidence-based approach provides a practical basis for the development of a bedside tool to alert and assist the care providers in their drug management decisions along the surgical pathway.


Adverse drug event Drug rules Medication related harm Surgery Tool development The Netherlands 



We are very grateful for the cooperation and input of the clinical pharmacists, the pharmacologists and the consulting surgeons for their input in the development of the surgical drug rules.


This study was made possible by funding of ZonMw, The Netherlands Organization for Health Research and Development (Project Number 170882706).

Conflicts of interest


Supplementary material

11096_2014_9941_MOESM1_ESM.docx (45 kb)
Supplementary material 1 (DOCX 46 kb)


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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Maya A. Ramrattan
    • 1
    Email author
  • Eveline B. Boeker
    • 2
  • Kim Ram
    • 2
  • Desiree M. T. Burgers
    • 3
  • Monica de Boer
    • 4
  • Loraine Lie-A-Huen
    • 4
  • Wilhelmina M. C. Mulder
    • 4
  • Marja A. Boermeester
    • 2
  1. 1.Department of Hospital PharmacyMaasstad HospitalRotterdamThe Netherlands
  2. 2.Department of SurgeryAcademic Medical CentreAmsterdamThe Netherlands
  3. 3.VieCuri Medical Centre Northern LimburgVenloThe Netherlands
  4. 4.Department of Hospital PharmacyAcademic Medical CentreAmsterdamThe Netherlands

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