Abstract

Background: Medication safety is essential for surgical patients whose medication regimens frequently change during the perioperative period. Polypharmacy increases medication complexity and associated risks, highlighting the importance of structured patient education.

Objective: To evaluate the effectiveness of a structured educational programme on medication safety and polypharmacy among surgical outpatients at University College Hospital, Ibadan, Nigeria.

Methods: A one-group quasi-experimental pretest–posttest design was employed. Of 117 planned participants, 111 completed both assessments. A structured questionnaire measured medication-safety knowledge, polypharmacy knowledge and reported practices. Four educational modules were delivered in English and Yoruba, incorporating simplified STOPP/START-based medication review. Paired-samples t-tests assessed changes.

Results: Medication-safety knowledge improved (mean difference −2.703, 95% CI −2.894 to −2.512; p < 0.001; Cohen’s d = 2.66). Polypharmacy knowledge increased from 7.00 ± 2.76 to 10.66 ± 1.17 (mean difference −3.658; p < 0.001; d = 1.50). Medication-safety practice scores increased from 8.60 ± 1.46 to 9.50 ± 1.01 (mean difference −0.892; d = 0.69).

Conclusion: Significant improvements in medication-safety knowledge, polypharmacy knowledge and reported practices were observed after the programme. The uncontrolled design limits causal attribution.

Keywords: Medication safety; Polypharmacy; Patient education; Surgical outpatients; Perioperative care; Nigeria.

Introduction

Medication safety is a central component of quality healthcare. Preventable harm may occur during prescribing, dispensing, administration, monitoring and self-management. Surgical patients are particularly vulnerable because analgesics, antibiotics, anticoagulants and other perioperative medicines may be added to existing treatments. This creates opportunities for omissions, duplication, interactions and misunderstanding.

Polypharmacy can be clinically appropriate, but unnecessary or poorly monitored medicines increase risk. Medication reconciliation, education and multidisciplinary review may help. Evidence on structured interventions for adult surgical patients in Nigeria remains limited.

Aim and objectives

The study evaluated changes in medication-safety and polypharmacy knowledge following a structured educational programme among surgical outpatients at University College Hospital, Ibadan. Its objectives were to assess pre- and post-intervention medication-safety knowledge, polypharmacy knowledge and reported medication-safety practices.

Methodology

Design and setting

A one-group quasi-experimental pretest–posttest study was conducted in the Surgical Outpatient Clinic of University College Hospital, Ibadan, Nigeria.

Participants and sampling

Eligible participants were adult surgical outpatients aged 18 years or older who were taking multiple medicines and provided written informed consent. Critically unstable patients and individuals whose cognitive, psychiatric or communication impairment prevented participation without support were excluded. Of 117 participants initially enrolled and assessed, 111 completed the programme and follow-up assessment. Six were excluded from the final analysis owing to incomplete follow-up or loss to follow-up, approximately 5.1% attrition.

Educational intervention

The face-to-face programme was delivered in English and Yoruba across four weekly modules: (1) medication knowledge and understanding; (2) medication-safety practices; (3) polypharmacy awareness; and (4) simplified STOPP/START-based medication review. Each module included standardized materials, guidance and interactive discussion. The same structured questionnaire was repeated 2–6 weeks after the programme.

Measures and analysis

The questionnaire covered demographics, 12 medication-safety knowledge items, 12 polypharmacy knowledge items and 10 medication-safety practice items. IBM SPSS Statistics version 26 was used for descriptive statistics and paired-samples t-tests. Mean differences were calculated as pre-intervention minus post-intervention; the significance threshold was p < 0.05.

Ethical approval

Approval was granted by the Institute of Medical Research and Training (IMRAT), College of Medicine, University of Ibadan (reference UI/EC/26/0140). Institutional permission and written informed consent were obtained. Responses were coded and confidentiality maintained.

Results

All 111 participants completed both assessments. Mean age was 47.0 ± 16.4 years. Most were female (69.4%), and 63.1% were general surgery patients. Doctors were the most frequently reported source of medication information (52.3%).

Table 1. Sociodemographic characteristics

Table 2. Pre- and post-intervention outcome scores

The proportion with good medication-safety knowledge rose from 48.6% to 79.3%, and the proportion reporting good medication-safety practices increased from 44.1% to 56.8%.

Recognition of potentially harmful drug–drug interactions increased from 36.9% to 80.2%; recognition of interactions between herbal and prescribed medicines increased from 46.8% to 87.4%. Following the programme, 94.6% recognized the need to disclose all current medicines to healthcare professionals.

Post-intervention, 88.3% recognized the increased risk of adverse drug reactions from polypharmacy, 89.2% recognized drug–drug interaction risks, 95.5% recognized the importance of careful review in older or medically complex patients, and 92.8% recognized that medication review can identify unnecessary or potentially harmful medicines.

Discussion

The educational programme was followed by substantial gains in medication-safety and polypharmacy knowledge and smaller but statistically significant improvements in reported safety practices. Particularly notable gains concerned drug–drug interactions, herbal medicines and the value of complete medication disclosure.

The bilingual, structured programme addressed gaps that may persist when counselling occurs in busy outpatient settings. The findings are consistent with the importance of medication education and review emphasized in prior literature and WHO medication-safety initiatives.

However, the one-group pretest–posttest design cannot isolate the programme’s effects from other influences. Outcomes were knowledge and self-reported behaviours, not directly observed medication errors, adverse events or readmissions.

Implications for Practice

The authors recommend incorporating structured medication-safety education into perioperative assessment, preparation and discharge. Important areas include medication histories, drug–drug and herbal–medicine interactions, missed doses, adverse-reaction reporting and consultation before taking non-prescribed medicines. Coordinated input from clinicians and pharmacists remains essential.

Limitations

• The study took place in a single tertiary hospital, limiting generalizability.
• No concurrent control group was included, limiting causal inference.
• Self-reported behaviours may be affected by social-desirability bias.
• Follow-up measured short-term changes only.
• Direct clinical outcomes, including medication errors and readmissions, were not measured.

Conclusion

The structured educational programme was followed by statistically significant improvements in medication-safety knowledge, polypharmacy knowledge and reported medication-safety practices among surgical outpatients in Ibadan. Structured patient education may complement medication reconciliation, documentation, communication and multidisciplinary medication review.

Declarations

Acknowledgements

The authors thank Dr. I. O. Ojo and Dr. F. O. Opatunji of Lead City University for academic guidance and supervision, and the management, staff and participating surgical patients of University College Hospital, Ibadan.

Author contributions (CRediT)

Folasade Abimbola Adesina: Conceptualization, methodology, investigation, data collection, formal analysis, original draft, review and editing. Parvin Mozafari: Supervision and academic guidance. Both authors reviewed and approved the final manuscript.

Conflict of interest and funding

No conflicts of interest were declared. The study received no specific funding.

Data availability

Participant-level data are not publicly available owing to ethical and confidentiality requirements. Anonymized data may be requested from the corresponding author, subject to institutional approval.

Artificial intelligence use

AI tools assisted with language refinement, structure and editing. The authors reviewed the content and take responsibility for the manuscript; AI was not used to fabricate data or generate findings.

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