HN Summary
• Perioperative pharmacists improve patient safety and outcomes by reducing medication errors and complications in high-risk surgical care.
• They deliver significant cost savings and efficiency, preventing adverse events and shortening hospital stays.
• Their role supports better recovery and care transitions, strengthening Canada’s surgical systems amid rising demand and complexity.
As surgical volumes and patient complexity continue to rise across Canada, optimizing perioperative care has become a critical priority for health systems. Pharmacists working in perioperative and surgical care play vital—yet often underrecognized—role in improving patient safety, clinical outcomes, and system sustainability. From preoperative medication reconciliation to postoperative recovery and discharge, these pharmacists are key members of the surgical team, ensuring safe and effective medication use at every stage of care.
Medication safety in a high-risk environment
Surgical patients are particularly vulnerable to medication-related harm. Canadian data indicate that medication- and fluid-related errors are among the most common adverse events in hospitals, second only to surgical errors themselves. Nationally, the Canadian Institute for Health Information (CIHI) reports that approximately 1 in 17 hospital stays involves some form of patient harm, translating to roughly 150,000 incidents annually, many of which are preventable medication-related events.
The perioperative setting is especially complex, involving time-sensitive, high-alert medications such as anticoagulants, anesthetics, opioids, and antimicrobial prophylaxis. Systematic reviews demonstrate that pharmacist-led interventions in perioperative care are associated with reductions in medication errors, improved pain control, lower rates of venous thromboembolism (VTE), and fewer postoperative complications.
Improving outcomes and reducing costs
Canadian research provides compelling evidence of the value perioperative and surgical pharmacists bring to both patients and the health care system. A landmark prospective study conducted in a large Canadian tertiary care hospital showed that pharmacists working on surgical wards made 1,097 clinical interventions over six months, with a 98% acceptance rate by surgeons and care teams. Importantly, one-quarter of these interventions had a 40% or greater probability of preventing an adverse drug event (ADE), directly improving patient safety.
The economic impact was equally significant. The study estimated $680,000 to $1.36 million in cost avoidance, primarily by preventing ADEs and reducing length of stay—equating to approximately $7 saved for every $1 invested in clinical pharmacy services. These findings reinforce that perioperative pharmacists are not only clinical experts but also stewards of health system resources.
Supporting enhanced recovery and transitions of care
Pharmacists in perioperative settings also play a central role in Enhanced Recovery After Surgery (ERAS) pathways, opioid stewardship, antimicrobial optimization, and seamless transitions of care. By ensuring appropriate medication selection, dosing, and duration, pharmacists help reduce postoperative complications, hospital readmissions, and avoidable delays in recovery.
As Canada’s population ages and surgical patients present with increasing multimorbidity and polypharmacy, the need for specialized perioperative pharmacy expertise continues to grow. National workforce data from CIHI highlight the expanding scope and importance of hospital pharmacists in managing complex medication regimens across acute care settings.
Leadership in practice: Eric Romeril, B.Sc. Pharm, ACPR, RPh.
A leading example of perioperative pharmacy practice in Canada is Eric Romeril, Clinical Resource Pharmacist – Perioperative Services at Hamilton Health Sciences. In this role, Eric supports perioperative services across five hospital sites, collaborating with surgeons, anesthesiologists, nurses, and allied health professionals to improve patient outcomes throughout the perioperative continuum. His practice spans interventional radiology, diagnostic imaging, nuclear medicine, endoscopy, and other procedural areas, advancing safe, evidence-informed medication use in some of the organization’s most complex and high-acuity care environments.
Building on this broad clinical and systems experience, Eric serves as Chair of CSHP’s Perioperative and Surgical Care Community of Practice. In this role, he leads a national network where perioperative pharmacists support one another on real world challenges involving workflow, policy, and medication system practices.
“Working in a more specialized practice area, it has been invaluable to connect with peers from across Canada to help understand how other organizations are approaching problems and common questions especially with things like policy, hospital practices, and other issues that are not well addressed by published literature,” Eric emphasizes.
A critical investment in surgical care
As health systems face ongoing pressures related to surgical backlogs, patient safety, and fiscal sustainability, pharmacists working in perioperative and surgical care represent a high-value investment. The evidence is clear: integrating pharmacists into surgical teams improves outcomes, reduces harm, and delivers measurable cost savings for the Canadian health care system.
By recognizing and supporting these roles—and the leaders advancing them—Canada can continue to strengthen perioperative care and ensure safer surgical journeys for patients nationwide.