Beyond surgery: improving adherence to essential pre‐ and post‐operative medications

Ross Porter, Jin W Hah, Chinnappa T. Reddy, Yasuko Maeda

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Missed medications are commonplace in hospital. Missing critical medications (e.g. antibiotics, cardiac medications, thromboprophylaxis) are unsafe and can significantly impact surgical outcomes. We assessed the extent of omitted or delayed medications in a tertiary colorectal surgery centre. Medications not prescribed on the standard Kardex were not included. Following the first round of data collection, a ‘Recognise‐Assess‐Consider‐Escalate’ (RACE) algorithm was implemented which aimed to reduce the number of missed critical medications. Pre‐intervention (n = 40 patients) there were 573 missed medication doses; 104 were critical medications. The median (Q1, Q3) number of missed medication doses per Kardex was 8 (2.25,20). The median number of missed critical medication doses per Kardex was 2 (1,4). The most common reasons for this were patient refusal (167/573, 29%), route unavailable (124/573, 22%), dose withheld on doctor's instructions (94/573, 16%) or reason not documented (76/573, 13%). Post‐intervention (n = 31 patients) there were 228 missed medication doses; 60 were critical medications. The median number of missed medication doses per Kardex was 4 (2,12). The median number of missed critical medication doses per Kardex was 0 (0,1). The most common reasons for this were patient refusal (75/228, 33%), route unavailable (20/228, 9%), dose withheld on doctor's instructions (42/228, 18%) or reason not documented (32/228 14%). Overall, the number of missed critical medications per Kardex was reduced (P = 0.014). There were no adverse incidents post‐intervention. The RACE algorithm has the potential to reduce the extent of missed critical medications for colorectal surgery patients. Further work should assess the impact of RACE on length of hospital stay, morbidity and mortality.
Original languageEnglish
Article number120
JournalColorectal Disease
Volume22
Issue numberS1
Publication statusPublished - 6 Jul 2020
EventAssociation of Coloproctology of Great Britain and Ireland Annual Meeting - Edinburgh, United Kingdom
Duration: 6 Jul 2020 → …

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