Improving Post-Operative Medication Compliance

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.