A new “surgical emergency care bundle power plan” improves physician prescribing compliance for emergency surgical admissions

Abstract Background Medication errors and omissions remain a significant source of preventable harm in emergency surgical care. Structured electronic order sets (“power plans”) may improve compliance with evidence-based prescribing practices. This study evaluated the impact of a new “surgical emergency care bundle power plan” on prescribing compliance in emergency surgical admissions. Methods A prospective two-cycle quality improvement audit was conducted across two hospital sites within a UK NHS Foundation Trust. All emergency surgical admissions during a defined one-month audit period were included. Compliance was defined as prescribing essential medications and requesting investigations within six hours of the documented decision to admit. Following baseline data collection, a structured electronic order set (“surgical emergency care bundle power plan”) was implemented within the Cerner Millennium electronic prescribing system, supported by education and training. A second audit cycle was subsequently performed using identical methodology. Results A total of 560 emergency surgical admissions were included across the two audit cycles (Cycle 1: n = 280; Cycle 2: n = 280). Baseline compliance was low across several prescribing domains. Following implementation of the power plan, compliance improved across all measured parameters: VTE prophylaxis (25% to 70%), analgesia (60% to 82%), antiemetics (28% to 61%), gastric protection (44% to 46%), antibiotics (68% to 82%), intravenous fluids (72% to 90%), laxatives (8% to 60%), nutritional supplementation (5% to 70%), and next-day blood test requests (5% to 60%). Conclusions Implementation of the “surgical emergency care bundle power plan” was associated with clinically meaningful improvements in prescribing compliance across multiple domains of emergency surgical care. Structured electronic order sets represent an effective, scalable quality improvement intervention capable of reducing omission errors and supporting evidence-based clinical practice.