Preoperative cardiac drug administration in general surgical patients: a completed audit

Abstract

The aim of this study was to audit the preoperative administration of regular cardiac medication in general surgical patients and to determine if this can be improved with simple ward-based education. The notes and drug charts of 102 general surgical adult inpatients undergoing elective operations were analysed prospectively. It was noted whether the patient was on regular morning cardiac medication, whether this was given and, if not, whether a reason was recorded on the drug chart. An information sheet and brief verbal reinforcement was given to nursing staff and junior doctors and the review repeated in 111 patients. There was no significant difference in the number of patients on regular cardiac medication between the two review groups; 42% patients had one or more drugs omitted in the initial review. After education this reduced significantly to 20% (p = 0.023). When omissions on medical instruction were excluded, this became highly significant (p = 0.0029). There was also a significant decrease in the number of times 'nil by mouth' was stated as the reason for omission. As a general principle, all regular cardiac medication should be given preoperatively even when nil by mouth as there is evidence that abrupt withdrawal can have serious consequences. This audit demonstrates that with simple education, the proportion of regular cardiac drugs administered preoperatively can be significantly increased.