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Achieving a fourfold improvement in oral analgesia premedication as per National Institute for Clinical Excellence guidelines in day surgery patients.

William Long1, Ker Wei Tan2
1Crosshouse Hospital, NHS Ayrshire and Arran, Kilmarnock, United Kingdom. 2Crosshouse Hospital, NHS Aryshire and Arran, Kilmarnock, United Kingdom


Introduction: The National Institute for Clinical Excellence (NICE) recommend multimodal analgesia for post-operative pain. Oral paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) (if clinically appropriate) should be offered before surgery for all adult patients. No difference in efficacy between oral and intravenous (IV) paracetamol and NSAIDs. Oral medications are cheaper and produce less single use plastic compared to IV medications. 

Methods: Retrospective analysis of 100 adult patients who had undergone day surgery procedures. Education sessions for anaesthetists and nurses in admissions were undertaken. Posters to re-enforce these sessions were displayed in admissions and anaesthetic rooms. Post intervention, another 100 patients were analysed. A survey was conducted over what influenced change in practice.

Results: Pre-intervention: 17 were prescribed oral paracetamol and 7 oral NSAID. All received this pre-op. 45 received IV paracetamol and 22 received IV NSAID intra-operatively.
Post-intervention: 70 were prescribed oral paracetamol and 43 oral NSAID. All received this pre-op. 15 received IV paracetamol and 16 IV NSAIDs.
Survey results: 74% of anaesthetists had changed their practice. Departmental teaching on green theatre project to decrease environmental impact of anaesthesia and prompting by nursing staff in admissions were cited as the most impactful factors towards change.

Conclusion: There is scope to dramatically improve adherence to NICE guidelines, saving money and decreasing environmental impact. Both departmental teaching and empowering admission nurses to encourage a change in culture were found to effective at improving prescribing practices.