Michael Wilson, Aileen Clyde
University Hospital Crosshouse, Kilmarnock, United Kingdom
Date: February 2022
Background: Following day surgery at University Hospital Crosshouse, patients were given a standard prescription of 4 days supply of paracetamol and ibuprofen or 3 days supply of co-codamol. General practitioners complained patients were attending for further analgesia soon after surgery.
Methods: 200 day surgery cases were identified. Community pharmacy staff were asked if patients received analgesia in the 3 week period following surgery.
Results: 74.5% of patients required no further analgesia; 29.5% were already prescribed analgesia pre-operatively. 9.5% of patients attended for repeat pre-operative prescription, 5.5% of patients received repeat prescription of the same medication prescribed at discharge and 10.5% of patient prescribed alternative medication. Orthopaedics had the highest proportion of patients (25%) requiring additional analgesia.
Conclusion: Reasons for the further prescription of analgesia in the post-operative period could include: side effects of prescribed analgesia, stronger analgesia required, inadequate supply, new painful condition, surgical complication, requirement for step down regimen.
Following a stakeholder meeting the following changes were made:
-use of standardised prescribing bundles, providing 7 days of analgesia, on an electronic prescribing system which improves communication with GPs.
-Avoid use of combination medications to aid the step-down of analgesia
- Oramorph as strong opioid of choice for short-term higher strength opioid
-Update to the patient information leaflet
A re-audit cycle will take place once day-surgery services have increased following the Covid 19 pandemic.