AB165. SOH23ABS_094. Review of pre-operative prescription and management of essential regular medications in University Hospital Limerick: a clinical audit

Background: Co-morbidities and poly-pharmacy are increasingly prevalent among patients presenting for surgery. Most chronic conditions should continue to be treated while patients are in hospital, however in practice, a high proportion of inpatients have all regular medications held while fasting. For inpatients in University Hospital Limerick, there is no formal system of medication review prior to surgery. Current guidelines recommend continuing most anti-hypertensive medications particularly beta-blockers. Meanwhile, continuation of blood thinning agents, e.g., anti-platelet drugs is often a clinician-preference decision.

Methods: This was a prospective audit of drug chart of ten elective inpatients and ten emergency patients scheduled for a surgical procedure at University Hospital Limerick (UHL) between June 1st and July 5th 2022. We recorded which medications were administered or held on the morning of surgery. This formed part of a quality improvement project aiming to evaluate inpatient day of surgery pre-operative medication administration and to align clinical practice with evidence-based standards.

Results: Patients had been prescribed a variety of medications to be given on the morning of surgery, including anti-hypertensives, anti-platelets and inhaled medications. Anti-hypertensive agents of all modalities as well as anti-platelet agents were held prior to surgery in most cases. Notably, only one in five elective patients had their routine beta blocker given on the morning of surgery.

Conclusions: In contrast to current evidence, most patients did not receive routine pre-operative medications. Clear local guidance needs to be developed to improve adherence to international recommendations.

Keywords: Audit; quality improvement; pre-operative assessment; regular medications