The ever growing number of emerging micropollutants such as pharmaceuticals requests rapid and sensitive full-spectrum analytical techniques. Time-of-flight highresolution mass spectrometry (TOF-HRMS) is a promising alternative for the state-ofthe- art MS/MS instruments because of its ability to simultaneously screen towards a virtually unlimited list of suspect compounds and to perform target quantification. The challenge for such suspect screening is to develop a strategy which minimizes the false negative rate without restraining numerous false positives. At the same time, omitting laborious sample enrichment through large-volume injection ultraperformance liquid chromatography (LVI-UPLC) is advantageous avoiding selective preconcentration. A novel suspect screening strategy was developed using LVI-UPLC-TOF-MS aiming the detection of 69 multi-class pharmaceuticals in surface water without the a priori availability of analytical standards. As a novel approach, the screening takes into account the signal intensity-dependent accurate mass error, hereby assuring the detection of 95% of pharmaceuticals present in surface water. Subsequently, the validation and applicability of the full-spectrum method for target quantification of the 69 pharmaceuticals in surface water is discussed. Analysis of five Belgian river water samples revealed the occurrence of 17 pharmaceuticals in a concentration range of 17 ng L-1 up to 3.1 μg L-1.