CHPPC Module 7: Perioperative Pharmacy Introduction
MODULE 7: PERIOPERATIVE PHARMACY

Introduction: Surgery, the Operating Room (OR), and the Post-Anesthesia Care Unit (PACU)

Welcome to the fastest-paced and most protocol-driven environment in the hospital. This module will translate your existing skills in precision, verification, and workflow management into the zero-error world of perioperative pharmacy.

From Community Counter to Sterile Core

If the Emergency Department is the chaotic front door of the hospital and the ICU is the high-tech command center, then the perioperative suite—encompassing the pre-op holding area, the operating rooms, and the post-anesthesia care unit (PACU)—is the hospital’s precision-manufacturing plant. It is a world of calculated actions, checklists, and time-outs, where every step is meticulously planned and executed. For a pharmacist, this environment is less about complex clinical decision-making and more about flawless operational execution. The skills that made you an exceptional retail pharmacist—your meticulous attention to detail, your ability to manage high-volume workflows, and your unwavering commitment to getting the right drug to the right patient at the right time—are the exact skills that define an expert perioperative pharmacist.

In this module, we will demystify the surgical world. You will learn that the seemingly arcane rituals of the OR are simply robust safety protocols. You will see that your expertise in weight-based dosing, allergy verification, and controlled substance handling is not just relevant but absolutely critical. We will translate your knowledge of outpatient pain management into the acute setting of post-operative care and show how your understanding of drug interactions and side effects is vital for managing anesthesia-related complications. This is your transition from managing chronic care to ensuring safety in the most acute, procedure-focused moments of a patient’s hospital stay.

Retail Pharmacist Analogy: The High-Risk, Time-Sensitive Compound

Imagine you receive a prescription for the most complex, high-risk, and expensive sterile compound your pharmacy has ever made. It’s for a VIP patient, and it must be delivered across town within a very specific, narrow time window. Failure is not an option.

The entire surgical process is like preparing and delivering this single compound.

  • Surgical Prophylaxis: This is your initial ingredient verification and calculation. You triple-check the recipe (the surgical plan), confirm the patient’s weight and allergies (pre-op check), and calculate the precise, weight-based dose of the starting ingredient (the antibiotic) to ensure it’s at the right concentration at the exact moment the compounding process (the incision) begins.
  • Anesthesia Workflow: This is your controlled substance log for the most potent ingredients in the compound. You document every microgram withdrawn, administered, and wasted. The Anesthesia Record is your compounding sheet, and your signature is the final word on its accuracy.
  • Post-Op Pain & Nausea Management: This is the stability and ancillary labeling for your final product. You are anticipating the side effects (pain and nausea) that will occur after the compound is administered and preparing the supportive care (PCA and antiemetics) needed to ensure the patient has a smooth and comfortable experience.
  • Hemostasis & Reversal Agents: These are your emergency “spill kit” and antidotes. You have them prepared and ready just in case something goes wrong during the compounding process—an unexpected reaction (bleeding) or an overdose of a key ingredient. You know the exact reversal agent and the precise dose needed to neutralize the problem instantly.

As a perioperative pharmacist, you are the master of this entire process. Your job is to ensure every step is perfect, every dose is accurate, and every potential problem is anticipated and planned for. It is the ultimate application of your core pharmacy skills in a zero-error environment.

What You Will Master in This Module

This module is divided into four critical sections, each representing a core competency of the perioperative pharmacist.

Surgical Prophylaxis

You will become an expert in selecting, dosing, and timing pre-operative antibiotics to prevent surgical site infections, with a deep dive into weight-based dosing and intraoperative redosing schedules.

Post-Op Pain and Nausea Management

You will learn the principles of Patient-Controlled Analgesia (PCA) and multimodal antiemetic therapy, ensuring patients are safe and comfortable in the crucial hours after surgery.

Anesthesia Narcotic Workflows

You will master the secure and highly regulated process of controlled substance management for the OR, from dispensing to reconciliation, playing a key role in diversion prevention.

Hemostasis and Reversal Agents

You will become the go-to expert on the high-alert medications used to control bleeding and reverse the effects of anesthesia and anticoagulation, including agents like TXA, protamine, and naloxone.

The Goal: Flawless Execution

By the end of this module, you will have the confidence and competence to step into the highly structured world of the OR pharmacy. You will be able to anticipate the needs of the surgical and anesthesia teams, ensure the safe and secure handling of all medications, and serve as the ultimate medication safety expert in the perioperative environment.