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Sam Ley & Eilidh McGinnigle

Audit of Adherence to RAH Policy on Pre-Operative Cardiovascular and Oral Hypoglycaemics Medication in Elective Theatre Patients. Sam Ley & Eilidh McGinnigle. OUTLINE. Summary of pre-operative routine medication policy Our Question Method Results Conclusion & discussion

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Sam Ley & Eilidh McGinnigle

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  1. Audit of Adherence to RAH Policy on Pre-Operative Cardiovascular and Oral Hypoglycaemics Medication in Elective Theatre Patients Sam Ley & EilidhMcGinnigle

  2. OUTLINE • Summary of pre-operative routine medication policy • Our Question • Method • Results • Conclusion & discussion • Limitations & future plans • Your Questions

  3. POLICY SUMMARY Continue everything except: • Hypoglycaemic agents in fasting patients • Adjust insulin regimens • Stop MAOIs Advance decisions required for: • Anticoagulants/antiplatelets • Lithium • HRT/COCP

  4. QUESTION Do elective patients admitted before the day of surgery comply with the RAH preoperative medication policy regarding cardiovascular and oral hypoglycaemic agents?

  5. STUDY POPULATION • Admitted before day of surgery • Oral hypoglyaemics • Any CV medication excluding antiplatelet/anticoagulants • Elective hip/knee replacement • Elective cystoscopic procedures • Elective laparotomy

  6. METHOD • Audit over 5 weeks • Age/procedure/co-morbidity • Class of drug • Deviations • Reasons • Adverse Events

  7. RESULTS

  8. RESULTS

  9. CONCLUSION Do elective patients admitted before the day of surgery comply with the RAH preoperative medication policy regarding cardiovascular and oral hypoglycaemic agents? (YES)

  10. LIMITATIONS • Missing data • Relatively small data set • Elective cases only • No general surgical patients

  11. INCIDENTAL OBSERVATIONS • Protocol only displayed on Ward 26 • Ward medical staff unaware of it • Nurses are fully aware • Conflicts with ENHANCED RECOVERY PROTOCOL • No mention of new hypoglycaemic agents

  12. ENHANCED RECOVERY PROTOCOL • Developed at GJNH by elective ortho team • Premedication • Routine medication • Anaesthetic technique • Peri-operative analgesia REFERENCE: McDonald DA et al, An enhanced recovery programme for primary total knee arthroplasty in the UK-followup atone year, Knee (2011), doi: 10.1016/j.knee.2011.07.012

  13. POINTS FOR DISCUSSION • New hypoglycaemic medications • Stents and antiplatelet therapy • ERP

  14. FUTURE PLANS • ?Review of protocol • FY1 teaching session • Re-audit?

  15. QUESTIONS

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