Minimising an outpatient medication regimen after paediatric cardiac surgery.

Abstract

Background: We implemented a quality improvement initiative to optimise the outpatient medication regimen after paediatric cardiac surgery. A previous trial that limited furosemide found no readmissions for pleural effusion but an increase in pericardial effusions. A similar quality improvement project had implemented prophylactic non-steroidal anti-inflammatory drugs and found a decrease in readmissions for pericardial effusion. We used these results to design an outpatient medication regimen that minimises furosemide and uses only targeted ibuprofen and report readmission rates from this project.

Methods: Single-centre analysis of outcomes since the adoption of a quality improvement initiative aiming to limit outpatient diuretics (≤5 days) while using targeted ibuprofen to prevent pericardial effusion readmissions.

Results: Two hundred and one patients were eligible for analysis. Forty-one patients (20.4%) were prescribed >20 days of diuretics due to compliance failure and were not considered to have received a limited diuretic regimen, leaving 160 patients. Of those, 53 (33.1%) were correctly prescribed targeted ibuprofen based on meeting "high-risk" criteria. There was one readmission for pleural effusion and 2/160 (1.3%) readmissions for pericardial effusion. The previous prospective study of limited furosemide without ibuprofen had a pericardial effusion readmission rate of 4/61 (6.6%) versus the 2/160 (1.3%) after implementing the regimen described in this report (p = 0.04).

Conclusions: We describe a medication regimen using limited outpatient furosemide without increased readmissions for pleural effusions. Targeted ibuprofen was used for high-risk patients only, and there were fewer readmissions for pericardial effusions than in a previous trial that used furosemide alone.