IMPROVING POST-OPERATIVE MEDICATION COMPLIANCE IN A HIGH-TURNOVER CARDIOTHORACIC UNIT

Abstract

Objective

Prevention of common post-operative complications of cardiac surgery necessitates the prescription and early administration of a set ‘bundle’ of medications. Unfortunately, frequent turnover of prescribing staff poses challenges for maintaining consistent practices, leading to delayed administration and an increased risk of complications. Our audit aimed to evaluate the effectiveness of current post-operative prescribing, identify areas for improvement, and implement targeted interventions to enhance compliance with prescribing standards.

Design and method

Three successive audits were undertaken, each encompassing one week of typical cardiothoracic cases in December 2022, July 2023, and December 2023 respectively. Each cycle involved classifying prescribed medications into categories of prescribed/not prescribed and administered/not administered, assessed both pre- and post-ward round. The first cycle assessed baseline prescribing practices, the second implemented computerised prescription bundles and educational interventions for training staff, and the third encompassed visual instructions attached to both the admission pro forma and physical workstations. Prescription compliance was measured as the number of prescribed medications administered by the end of day one post-op as a percentage of the total number of indications. Errors were categorised into erroneously not prescribed and erroneously not administered in the second and third cycles only. Medications that were documented as intentionally held were categorised as compliant.

Results and conclusions

Results

There were 60, 25, and 45 patients included within the first, second and third cycles respectively. Mean (SD) prescription compliance was 79.0 (21.5), 89.1 (9.6) and 89.0 (12.4) per cent respectively. Prescription compliance pre-ward round was 51.8 and 44.9 per cent in the second and third cycles respectively. The second cycle contained 312 indicated prescriptions (versus 507 in the third), of which 6.1 (3.5) per cent were erroneously not prescribed and 5.4 (7.1) per cent were prescribed but erroneously not administered. By the third cycle, all medications were above 80% compliance with the exception of clopidogrel and the day-zero stat dose of pantoprazole.

Conclusion

Targeted interventions including prescriber education and computerised bundles can improve prescribing practices in a high-turnover cardiothoracic unit. Poor compliance with clopidogrel prescribing may be related to unclear post-operative instructions, and pantoprazole to an incorrect default prescription in the medication bundle. Ongoing efforts will focus on maintaining overall prescribing standards, encouraging pre-ward round prescription and administration and addressing specific challenges related to certain medications.