Valencia Rumampouw
Introduction
Non-steroidal analgesics (NSAIDs) are recommended for multiple day case procedures. Typically, oral ibuprofen or intravenous parecoxib are used, with no evidence for superior analgesia between any NSAID in this setting.
Pre-medication with oral analgesia is recommended for day case surgeries. Preoperative ibuprofen is 150 times cheaper than intravenous parecoxib, with fewer negative environmental impacts.
We created a Patient Group Directive (PGD) for pre-medication with 400mg oral ibuprofen in day surgery patients and audited this process.
Methods
Patients are routinely screened for exclusion criteria by their anaesthetist; the pre-medication process is driven by their nurse. Pre-operative ibuprofen is administered to suitable patients with no need for a doctor’s prescription.
We audited the first month using the PGD, analysing: the total proportion of patients receiving the pre-medication; proportion of suitable patients receiving the PGD; safety of the documentation process; and projected cost savings.
Results
Fourty-six percent (106/230) of patients undergoing general anaesthesia received the ibuprofen pre-medication in month one. In the first 57 cases, 75% (27/36) of patients with no contraindication received ibuprofen as a pre-medication. Of those who did not receive it, 70% (21/30) had a contraindication to NSAIDs.
Seventy-eight percent (21/27) of pre-medications were documented fully; the remaining 22% (6/27) were documented with minor omissions, with no patient safety implications.
Conclusions
Establishing a nurse-led pre-medication service for oral ibuprofen is feasible in a day case unit. Education has been delivered to staff to improve uptake. Projected cost-savings in our small unit are £6000 per annum, with significant environmental benefits
Authors
Valencia Rumampouw
Newcastle University, Newcastle Upon Tyne, United Kingdom
Sophie Benson
Newcastle University, Newcastle Upon Tyne, United Kingdom
Ashley Scott
The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom