Medicines matter: the expanding role of the perioperative pharmacist

This narrative vignette examines how perioperative pharmacists can prevent medication-related harm during surgical care. We present a case of a 78-year-old man with multiple conditions including atrial fibrillation, type 1 diabetes mellitus, heart failure and long-term steroid dependence undergoing robotic surgery for rectal cancer. Post-operatively, he developed persistent hyperglycaemia and tachycardia, progressing to acute heart failure with pulmonary oedema. When we reviewed the case, we found several medication management failures: inadequate steroid replacement, inappropriate insulin management, failure to restart betablockers and excessive fluid administration. This case shows why medication errors remain a leading cause of avoidable perioperative harm. As surgical patients get older and present with more complex conditions and medications, the risks multiply. While medicines reconciliation works well in acute care, perioperative settings face unique challenges. In practice, we find inconsistent application of medication safety protocols. We propose a proactive model where perioperative pharmacists engage early in the surgical pathway. Rather than waiting until after admission, they would perform medicines reconciliation and optimisation during preassessment. This allows for the creation of personalised medication plans that address drug interactions, dose adjustments and formulation changes needed for surgery. From 2026, pharmacy graduates will enter the workforce as independent prescribers. This positions perioperative pharmacists perfectly to enhance surgical safety through collaborative practice. As surgical demand increases and patients become more complex, integrating pharmacists as core providers is not just an opportunity; it is a necessity.