Introduction It was observed anecdotally that several trauma patients were not receiving routine oral meds due to being ‘Nil-by-mouth’. Our aim was to improve perioperative administration of regular medication for patients admitted with fractured neck of femur (NOF #) on the day of surgery.

Methods Data was collected from drug charts of those admitted to the Queen Alexandra Hospital, Portsmouth with NOF # in 2019. Good practice was mostly observed, however areas for improvement were identified in anticoagulation, cardiac and diabetic medication. In addition, the pre-op guidelines and drug trolley posters were not always available and were out of date. Change was implemented by updating the NOF # guidelines using up-to-date guidance.

The ‘Nil by Mouth’ drug trolley posters were re-designed and were re-distributed to every drug trolley on the orthopaedic wards and the nursing teams were informed of the changes.

Results Following re-audit, improvement was made in the following areas. Anticoagulation administration now had a 100% compliance. Rate-limiters administration had improved, as had the administration of antihypertensives (CCB). Parkinson’s medication, inhalers and alcohol withdrawal medication had continued to be consistently given. The reasons for omitting medication was documented. No improvement was made in the following areas: Gastric protection, oral analgesia, anti-anginals and more data was required to assess glycaemic management.

Conclusions Optimisation of these high-risk patients requires a multi-faceted approach but by improving basic aspects of care such as peri-operative medication, it is hoped that overall mortality and morbidity are reduced. Further education on this topic may be required to continue improvement.

References

1. UKCPA. 2019. The Handbook of Perioperative Medicines. [online] Available at: https://www.ukcpa-periophandbook.co.uk/[Accessed 10 February 2020].

2. Escardio.org. 2014. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. [online] Available at: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-ESA-Guidelines-on-non-cardiac-surgery-cardiovascular-assessment-and-management [Accessed 8 February 2020].