Medication Compliance on the Day of Surgery for Patients Seen at Anesthesia Pre-Op Clinics: Retrospective Chart Review
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1 Medication Compliance on the Day of Surgery for Patients Seen at Anesthesia Pre-Op Clinics: Retrospective Chart Review Dr. James Paul and Dr. Sean Middleton PGY3 Department of Anesthesia December 4, 2014
2 Medication Compliance Medication compliance is far-reaching problem in medicine (Non)adherence rate estimated at 50% Difficult to estimate noncompliance Self-reported Serum levels/markers Patients tend towards non-adherence Reconciliation also an issue JAMA Dec;288(22): JAMA June;268(21): NEJM Aug;353(5): Med Clin (Barc) Dec 15;139(15):662-7 Farm Hosp Jan- Feb;33(1):37-42
3 Pre-operative Evaluation Main goal of pre-operative evaluation is to reduce patient risk and morbidity Medication reconciliation and instructions vital component of pre-operative visit Considerable time spent discussing medications with patients No specific recommendations from CAS/ASA regarding medication instructions Many studies examining how to optimize pre-operative medication instructions Clinical anesthesia. 6th ed. c2009. Chapter 23 Anesthesiology 2012; 116:522 38
4 Compliance In Anesthesia Few studies examining perioperative compliance in anesthesia Most examined efficacy of instructions given Only one study looked specifically at compliance 13/59 (22%) patients surveyed took their medications in spite of instructions to do otherwise Internal Quality Assurance at HHS on compliance Noncompliance rate 36% Recent study as well Anaesthesia May;56(5):481-4 Anaesthesia Aug;57(8): Anaesth Intensive Care Jun;34(3): Ir J Med Sc Jul, Aug, Sept;167(3): Gravel MA, MacInnis. MedicaPon History: From Pre- Op Clinic to
5 Predictors of Compliance In literature, medication compliance predicted by: Age Race Comorbidities In elderly, no specific predictor has been ascertained to predict noncompliance Could compliance improve if we could identify those who may not adhere to instructions? Anesthesiology 2014; 121:29-35 Clin Ther Jul-Aug;20(4):764-71
6 Pre-operative Medication Instructions At MUMC pre-operative clinic: Medication reconciliation done Instructions recorded on chart by anesthetist Carbon copy given to patient On day of surgery Medication history by nurse in SDS Adherence recorded by nurse Anesthetist reviews chart prior to patient going to OR
7 Anesthetic Record
8 Objectives Primary Objective: To determine the proportion of patients undergoing non-emergent surgery who are non-compliant with medication reconciliation instructions, and to identify predictors of noncompliance Secondary Objective: To investigate the potential impact of noncompliance
9 Methods Retrospective chart review Six months of data Using noncompliance rate 22% to calculate sample size Sample size of 650 (800 MRNs to be used) Inclusion criteria: Six months of patients undergoing surgery at HHS between May and April Multiple surgeries only first POHMR to be used Exclusion criteria: Age 17 years Emergency surgery Organ harvest surgery Patients not taking medications
10 Methods Determining compliance: Patient is either compliant or noncompliant Individual medication compliance also recorded Possible predictors of noncompliance: Age Gender ASA class Number of medications Type of Surgery Time between pre-op and surgery Reconciliation by pharmacist or anesthetist at clinic Comorbities Medication class
11 Methods Possible effects of noncompliance: hemodynamic effects hypo-/hyperglycemia bleeding bronchospasm OR delay unanticipated admission Data entry done on customized RedCap database Regression analysis to be done on possible predictors and possible effects
12 Methods Data sources Patient list from Decision Support Corresponding Meditech information Corresponding scanned chart on Sovera Inter-rater audits 20% of monthly data entry will be audited and reconciled by myself
13 Final Notes Larger, more applicable ramifications of study: Efficiencies at pre-operative clinic Identify areas for further study in peri-operative medicine Are we any good at instructing patients? Concurrent qualitative study Sources of noncompliance Benefits of noncompliance?
14 Thank You Thank you to Dr. Paul, Toni Tidy, Maria Pyne, and Lehane Tabane. Questions?
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