Reducing missed medications in surgical patients
Elective surgical patients need accurate drug charts to reduce missed medication doses, decreasing the chance of peri-operative complications. The quality improvement project described in this article used four interventions to improve the percentage of missed medication doses. A driver diagram was produced to interrogate the current pathway which highlighted multiple interventions, including changes to elective pro formas, the initial clerking process and nurse-based prescribing. Once implemented, a plan-do-study-act (PDSA) cycle was completed as per NHS Improvement guidelines. Overall, missed medication dose percentage decreased from 9.8% to 0% after the interventions. Two of these changes have been deemed sustainable and have been integrated into elective patient pathways, improving both patient safety and streamlining surgical elective patient services. This project highlights the importance of prescribing practice in a multidisciplinary team. Simple changes to established systems allow for better patient care, and the authors' project provides evidence that empowering nursing staff to take the lead in the medication management of patients can reduce the likelihood of negative outcomes in a patient's admission.
Following a number of patient safety incidents in elective surgical admissions, the general surgery department at Poole Hospital sought to improve prescribing practices in elective admissions and take steps to prevent similar errors recurring in future. Medical errors are estimated to contribute towards 1708 deaths a year in England (Elliott, 2021). Preventable adverse drug events are responsible for 20% of injuries or death to patients each year (O'Malley, 2007). Peri-operative prescribing errors have been described previously within otolaryngology patients, with documentation of medication histories being highlighted as one of many reasons for this (Rosenwasser et al, 2010).
The authors found that these errors predominantly affected frail patients who were taking multiple medications or those on medications that need to be given in a timely manner: for example, Parkinson's medications that, if missed, could have negative outcomes for the patient. These discrepancies have been shown in multiple studies (Beers et al, 1990; Cornish et al, 2005).
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