971 PERIOPERATIVE MEDICINE PRESCRIBING IN OLDER ADULTS - IMPROVING PRESCRIBING ACCURACY USING QUALITY IMPROVEMENT METHODOLOGY

Introduction

Accurate medication prescribing perioperatively is an essential component of peri-operative optimisation. Older adults are uniquely vulnerable due to polypharmacy and age-related changes in pharmacokinetics and pharmacodynamics. Barriers to this include the urgency of surgery, unclear drug history and poor knowledge of how to manage the patient’s medications. This quality improvement project aimed to improve the accuracy of regular medications prescribed in older adults undergoing emergency laparotomy.

Method

Multiple Plan, Do, Study, Act (PDSA) cycles were conducted at Southend University Hospital. Patients over 65 undergoing emergency laparotomy were included. Regular medications were retrospectively analysed to assess whether they were continued or suspended appropriately in the perioperative period, according to UKCPA guidelines. The initial cycle analysed prescribing practices for nine medications which were pre-defined as ‘high risk’ of causing adverse effects when prescribed inappropriately. Subsequent cycles scoped all regular medications. Our interventions aimed to increase conscious prescribing by improving prescriber education. Interventions included introducing joint Geriatrician & Surgeon-led teaching sessions, and dissemination of a poster guide with links to resources to aid decision making.

Results

First cycle (September—November 2020): 32 patients included. Only 30% of all regular medications were within the ‘high risk’ group; 50% of which were prescribed appropriately. Second cycle (May—July 2021): 26 patients included. 72% appropriately prescribed regular medications. Third cycle (September—October 2021): 13 patients included. Sustained improvement in prescribing accuracy to 75%. Problems identified include 1) delay in prescribing 2) regular medications not prescribed 3) prescribed but not administered.

Conclusion

Improvement in prescribing accuracy amongst doctors is achievable following education-focused intervention. The goal is active decision making with every drug prescribed. Integrating this inter-departmental teaching session into Induction teaching is a sustainable method to improve prescribing practice. This can be translated to every surgical department.

Refractory hypercalcaemia secondary to localised gastrointestinal stromal tumour

Gastrointestinal stromal tumours are a rare form of intra-abdominal neoplasm derived from mesenchymal tissue, typically presenting with abdominal pain, anaemia or bleeding into the bowel or abdominal cavity. Hypercalcaemia is an unusual complication, having been documented in only seven previous patients, all of whom had advanced metastatic disease. We present a case of treatment-resistant hypercalcaemia in a patient with non-metastatic gastrointestinal stromal tumour, which resolved following excision of the tumour.