Improving peri-operative medicine administration for patients having non-elective surgery
Project leads: Lucy Powley, Sean Botham and Alison Colhoun
St James’s University Hospital (SJUH) is one of 7 hospitals forming the Leeds Teaching Hospitals Trust. It has a total of 1122 beds, including 283 surgical beds, SJUH offers both elective and non-elective surgical treatment for a range of specialities – general surgery, upper and lower gastrointestinal surgery, urology, breast, transplant, ophthalmology and thoracis. Surgical beds are spread across 17 wards.
Patients attending SJUH requiring admission for non-elective surgery have their regular medications prescribed however the perception was that these were often omitted by the nursing staff prior to surgery as they were nil by mouth (NBM). This policy can lead to complications in the preoperative period particularly if patients have a prolonged wait for surgery.
Assessment of the Problem and Analysis of its Cause
Drug charts from 50 inpatients having non-elective surgery were reviewed. Data was gathered regarding the name and number of medicines omitted and reasons for omission. Of those patients prescribed oral medications 64% had medication with given or withheld inappropriately. Survey data investigating the cause of the problem was collected from ward staff including; occupation, confidence level regarding perioperative medicine administration, knowledge test regarding 14 different classes of drugs and whether they should be withheld prior to surgery and what action would staff currently take. All staff made errors on the knowledge test, with a mean error rate of 3.5 per staff member. Confidence level did not correlate with number of errors made.
A poster was created in consultation with pharmacy, the anaesthetic consultant body, and the medicines safety committee. Posters were printed and displayed in every drug cart on every surgical ward, every clinic room and every doctor’s office. The poster was advertised and explained in a series of mini educational visits of approximately 5 minutes duration to each ward. A teaching presentation was delivered at the foundation doctor weekly teaching where a small handout version of the poster was distributed. The poster was distributed via informal hospital networks such as ward what’s app groups where they existed.
Assessment of Change
Review of 60 drugs charts from patients having acute surgery showed 88% of patients had their medication given appropriately an increase from 36%. Mean numbers of errors pre intervention was 3.5 per staff member, post intervention mean errors were down to 0.75 per staff member with all staff groups showing a decrease in error rate. 90% of respondents to the survey felt the poster was useful, the remaining 10% were not aware of the poster.
The production of a one page easy to follow guide to perioperative medicine administration along with a package of educational interventions has led to a significant improvement in the number of patients having their medicines given appropriately in the perioperative period. Simple highly visible interventions when backed up with education can have a significant impact on safe patient care. Involving all staff groups was vital in the success of this intervention.