Anushka Jindal
Introduction
Safe perioperative prescribing is essential to maintain chronic disease control&reduce avoidable complications. NICE perioperative care guidance recommends preoperative assessment and optimisation that considers co morbidities and medicines. BNF treatment summary on surgery and long-term medication notes that stopping long-term medicines may risk loss of disease control. This audit assessed adherence to the guidelines in elective hepatobiliary and pancreatic(HPB) surgery and evaluated change following intervention.
Methods
A retrospective closed-loop audit was undertaken in HPB surgery wards at a tertiary care centre. Electronic patient records were reviewed for elective patients admitted the day before surgery, and regular medications were compared against Trust guidance on medicines to continue or omit preoperatively. Cycle-1 ran from 25 April to 8 May and Cycle-2 from 24 October to 5 November. Included patients were elective admissions taking regular medications; those not taking regular medicines were excluded. Eighteen cases were reviewed in Cycle-1 and 15 in Cycle-2. Between cycles, poster summarising medications to continue and omit preoperatively was introduced.
Results
In Cycle-1, some eligible medicines, including beta blockers, inhalers and thiazides, were prescribed, whereas many medicines suitable for continuation, including proton pump inhibitors, statins, calcium channel blockers, antidepressants, thyroid medications and antiretrovirals, were omitted. Compliance improved from 5.5% to 13.1% following intervention, although overall adherence remained poor. Reported barriers included short staffing and clerking by locum doctors.
Conclusion
Adherence to preoperative prescribing guidance in elective HPB surgery was poor, with only modest improvement after intervention. Improved medication review, documentation and targeted staff education may improve compliance.
Authors
Anushka Jindal
Barts Health NHS Trust, London, United Kingdom