Elective surgery cancellations: do you catch these patients?

Background

Patients are often advised to withhold their medications prior to surgery. If the surgery date changes, a plan regarding medicine use needs to be communicated to the patient. Bulk cancellations of elective surgery due to the COVID-19 pandemic highlighted a gap in practice.

Aim

To report on intervention rate and time taken for pharmacist review of patient medications when bulk cancellations of elective surgery occurred.

Method

A screening tool was developed for nursing staff to identify patients on high-risk medications. Medication plans were developed by the pharmacist, with input from the broader surgical team. Time spent was recorded by the pharmacist. Data were collected over a 3-week period in July 2022. This project was exempt due to the local policy requirements that constitute research by the Metro South Human Research Ethics Committee (Reference no: CM0602202402). The justification for this exemption was as follows: the study complied with Chapter 2.3 of the National statement of ethical conduct in human research and presented no foreseeable risk of patient harm.

Results

The pharmacist reviewed 154 cancellations, of which 17% (n = 26) required intervention by the pharmacist as they met the high-risk criteria identified by the screening tool. Of these, 34% (n = 9) had not attended pre-admission clinic for an original medication plan. The time to conduct a pharmacist review ranged from 10–14 min. At the time of cancellation, 84% (n = 130) of patients were awaiting a new surgery date. Surgical specialties most implicated included orthopaedic surgery (36%, n = 55) and urology (17%, n = 26). The average time between the cancellation date and a new surgery date was 7 days.

Conclusion

A pharmacist-led process to review medication plans in patients whose elective surgery procedure date had been cancelled was developed. Communication of these plans is essential to ensure patient safety and reduce medication-related harm.