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Perioperative Care

Post operative medications review

Careful consideration is needed to ensure that medication is optimal in the peri-operative period. This may include starting new medicines or more commonly planning when and how patients will take their own medication.

During the review of a patient’s medication, the below should be considered (please note that local guidelines should always be followed regarding changes to specific medications mentioned).

  • What are the patient’s normal medications?
  • What should be stopped and when should it be restarted?
  • What should continue?
  • Can anything be optimised?
  • Is any anti-coagulation bridging therapy required?
  • What should be started?
  • Are there any additional specialist medications required?
  • Are there any specialist bloods that need to be taken?
  • Consideration of fluids and electrolyte replacements within the review
  • Analgesia

What we’ve learnt

Our experience has been that sometimes it is the most basic things that can make a difference when it comes ensure patients receive optimal medicine management in the perioperative period. This includes:

  • Good communications between the medical, surgical and ward teams are required with clear written instructions.
  • Checking whether medications have been omitted and why (not just that they are prescribed or not).
  • Ensuring antibiotics are reviewed and stopped appropriately.
  • If a drug is not tolerated that an alternative is considered.
  • Ensuring appropriate bloods are sent for required levels.
  • If a patient is nil by mouth or has an NG in-situ can they still safely receive oral medication or is there an alternative route that can be used.
  • Providing good junior doctor and nurse education and guidelines to follow.
  • Make sure that patients are only discharged on required medications and appropriate referrals to specialist teams are made if there are changes.
  • Medication which has been stopped should be clearly communicated to the patients GP.
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