Background Proper prescription of perioperative antibiotic prophylaxis (PAP) and postoperative analgesia have been shown to decrease morbidity and mortality, and hospital stay in hospitalised surgical patients.
Purpose To analyse compliance of prescription of PAP and postoperative analgesia in patients undergoing elective surgery in a general surgery service with consensus documents and to identify improvement opportunities.
Material and methods Observational cross sectional study conducted in the general surgery department of a referral hospital area. Patients undergoing elective surgery for 1 week were included. Clinical patient information was collected from the electronic medical record (Selene), treatments from the prescription program (Savac) and applied surgical protocols from the anaesthesia digitised reports. From these data, we analysed: (a) PAP administered to each patient (antibiotic, dosage and duration). Compliance with the centre protocol was assessed by the degree of infection risk by surgical procedure intervention, patient related factors and possible contraindications; (b) analgesic treatment scheme, checking: start treatment according to the expected level of pain, transfer to ward with visual analogue scale (VAS) score <4 and considering expected rescue uncontrolled pain and prevention of post-surgical vomiting.
Results 37 patients were included in the study, with an average age of 45 years. 20 were female. In the analysis of PAP, compliance was: 76% in clean surgery, 100% in clean/contaminated surgery and 89% in contaminated surgery. The reasons for failure were: unnecessary administration of PAP in clean surgery (83%) and selection of the wrong antibiotic agent (17%). In 4 patients the duration of prophylaxis was not appropriate and exceeded 48 h after surgery but was justified in 2 cases. Moreover, interventions with expected mild to moderate pain (92%) were treated properly, but in 4 patients supplemental rescue analgesics were omitted. In moderate-severe (3%) and severe (5%) pain, an analgesic regimen was always adequate. No VAS records were found. The prescription of an antiemetic regimen was fulfilled in 60.71% of cases.
Conclusion Compliance with centre guidelines for PAP was high. Non-compliance issues were unnecessary administration of PAP and inappropriate duration. The postoperative analgesic protocol also had a good degree of compliance but it is necessary to insist on the importance of rescue analgesic regimens, prevention of post-surgical vomiting and use of VAS for pain measurements.
References and/or Acknowledgements Thanks to the General Surgery Department.
No conflict of interest.
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