An audit of 143 surgical admissions showed that only 30% of general surgery and urology patients have complete medication charts on the day of surgery prior to going to theatre, compared to 94% of orthopaedic patients. This was despite having been seen previously in the pre-operative assessment clinic (POAC). These patients went to the wards post-operatively, where many then missed doses of their life-sustaining medications. Orthopaedic patients see a prescribing pharmacist in POAC who undertakes medicines reconciliation; this is performed by junior doctors for surgical patients.We designed three interventions to improve drug chart completion by junior doctors, and gathered prospective data for 22 weeks in the POAC. We also recorded attendance of junior doctors in the POAC and reasons for absence. Daily and weekly percentages of drug chart completion were plotted on a run chart.The baseline completion rate was 43%. This rose to 45% after the first and second interventions, and 51% after the third intervention. However, the completion rate remained markedly below our target of 94%. Junior doctors attended only 44% of POACs. They reported being “too busy to attend” 41% of the time, and could not be contacted on 11% of occasions.Junior doctors reported that they were unable to attend to both unwell inpatients and the POAC, the latter seeming less of a priority. This was despite a rota allocating doctors to attend POAC sessions free from clinical or teaching commitments.We were unable to increase the rate of drug chart completion with the resources available. We therefore recommend the employment of prescribing pharmacists in the POAC for general surgery and urology patients.
Background In our large teaching hospital, Pre-Operative Assessments (POA) for general surgery patients are completed in a single visit by a multidisciplinary team comprising trained nurses, anaesthetist and junior doctors. Medicines reconciliation and completion of thromboprophylaxis risk assessment (TRA) are completed by junior doctors. For orthopaedic patients, these are completed by trained pharmacists. Missed doses as a result of incomplete POA for general surgery patients were identified as a major risk at our institution. Purpose We carried out a prospective study comparing the reliability of medicines reconciliation performed by junior doctors compared to pharmacists, before and after implementation of three interventions that are listed below. Materials and methods We collected data on completion rate of prescription charts and TRAs of all patients who attended POA for general surgery and orthopaedic for 2 weeks, and the number of missed doses for 2 weeks. Following that, the completion rate of all patients attending POA for general surgery was continuously monitored over a period of 22 weeks. A fishbone diagram was used to analyse the POA process and to identify possible targets for interventions. We implemented three interventions: All junior doctors receive a mandatory medicines reconciliation and TRA teaching session. Junior doctors to complete all prescription charts as a batch at the end of POA clinic. Patients were not permitted to be transferred to theatre without a complete prescription chart. Data were plotted in a run-chart for analysis. The attendance rate and reasons for nonattendance of junior doctors at POA were also recorded. Results The completion rate of prescription charts and TRA for general surgery and orthopaedic patients was 43% and 94% respectively. Over a period of one week, 18 cases of missed doses were recorded. Following the first two interventions, the completion rate of prescription charts for general surgery patients increased to 45% and to 51% after the third intervention. Junior doctors attended only 44% of POA clinics, with the majority being kept away by other clinical commitments. Conclusions Preventing medicines errors in elective surgical patients begins with accurate medicines reconciliation and completion of prescription charts at POA clinic. Our data revealed that junior doctors were not as reliable as trained pharmacists in completing prescription charts. Despite three interventions, the completion rate of prescription charts by junior doctors could not be raised to meet the standard of trained pharmacists. We therefore support the introduction of trained pharmacists to the POA clinics to manage medicines reconciliation and reduce medicines-related incidents. No conflict of interest.
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