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

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 SUMMARY Cardiac51/140 (36%) 33 Cystoscopy 7 Hips 11 Knees Diabetic16 (11%) 12 Cystoscopy 2 Hips 2 Knees Missing data13/153 (8.5%)

8. RESULTS POLICY DEVIATIONS Cardiac patients (51)1 ? reason (BB & CCB) 1 mis-prescribed (BB) Diabetic patients (16)1 patient self medicated DOCUMENTED ADVERSE OUTCOMES Nil

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