FP5.9 - Improving the pre-operative administration of medications for patients requiring emergency surgery who are ‘nil-by-mouth’ (NBM)

Abstract The statement ‘nil-by-mouth’ can be misleading with regards to drug administration. Inappropriate pre-operative drug omission or administration can lead to poor patient outcomes, experiences and increased hospital stays. The aim of this quality improvement project was to reduce the number of patients who had regular medications incorrectly administered, omitted or experienced pre-operative medication-related complications. Two interventions were delivered targeted at educating junior doctors and nursing colleagues. Electronic records of general surgical patients requiring emergency surgery in a district general hospital were reviewed. Data on incorrect medication omission, administration and medication-related perioperative complications was retrospectively collected. The percentage of patients who had medications incorrectly administered was 11% pre-intervention, 11% after intervention 1, and 6% after intervention 2. There was a reduction in the number of medications incorrectly omitted from 57% pre-intervention, to 40% after intervention 1 and 0% after intervention 2. One peri-operative medication-linked complication was recorded prior to the interventions which fell to zero cases following both interventions. A sustained reduction in incorrect drug omission and medication-related perioperative complications has been shown following interventions 1 and 2 together, highlighting the importance of involving all members of the multidisciplinary team when aiming to improve how medications are handled preoperatively. No statistically significant change was made to the incorrect administration of medications pre-operatively. This is likely a reflection on the prescribing clinicians within the on-call team who rotate twice weekly. Other interventions targeting a consistent member or process within the on-call team should be explored to ensure follow-through going forward.