The Pharmaceutical Journal
Vol 269 No 7224 p702
16 November 2002

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National Confidential Enquiry into Peri-Operative Deaths (NCEPOD) (www.ncepod.org.uk)

Patients fail to receive many essential regular medicines before operations

Many patients are not being given essential regular medicines before operations, according to data collected as part of the National Confidential Enquiry into Peri-Operative Deaths (NCEPOD).

The enquiry looked at a sample of all the perioperative deaths reported to it and asked how many patients were on specified treatments and whether drugs were given on the morning of an operation. The percentage of cases where drugs were not given before urgent, scheduled or elective operations was also recorded (see Table 1). These patients should have been able to receive their medicines before their operations.

The NCEPOD report for 2001–02, entitled "Functioning as a team", says: "Of concern is the information on antianginal, bronchodilator and steroid treatment. These drugs should be given throughout the operative period and when the patient cannot take their oral drugs, there are simple topical, inhaled or parenteral replacement preparations readily available." In terms of patients who have been classified as "nil by mouth", the report says: "Doctors and nurses need to understand the difference between preoperative oral medication and the full English breakfast."

The report calls for national guidelines for prescription writing in hospitals to be established in order to reduce drug errors. Dose alteration on prescriptions is not uncommon, it says, but often it is not possible to know the time or date when the alteration was made, or who made it.

It suggests that new signed and dated prescriptions should be made when doses are altered so that the sequence of events can be followed. The report says that increasingly hospital pharmacists are monitoring drug prescriptions and that they are qualified to determine the clinical suitability of a prescribed medicine. Experienced nursing staff should also be encouraged to question prescriptions if they have concerns.

Copies of the report can be downloaded from the NCEPOD website (www.ncepod.org.uk) or ordered (price £20 including packaging and post) from NCEPOD, 35–43 Lincoln's Inn Fields, London WC2A 3PE.