LAUSR

Ensuring correct medications are prescribed for all patients admitted with neck of femur fractures is essential for presurgical optimisation, analgesia and perioperative care. This quality improvement project examines patients over the age of 65 who were managed following the orthogeriatric pathway for all neck of femur fractures at Queen Elizabeth Hospital, Woolwich. Guidelines exist that include a list of medications that should be prescribed for all of such patients on admission, including VTE prophylaxis, analgesia, antiemetics, laxatives, IV fluids and preload. The aim is to improve the rate of following this guidance on prescription by clerking doctors on admission. Data was collected retrospectively for all patients admitted to Queen Elizabeth Hospital between 03.12.19–15.01.20 with a neck of femur fracture. Interventions were then introduced to improve medication prescriptions and took place at the start of February 2020. This involved tutorial sessions and raising awareness through posters. Data collection for cycle 1 following interventions took place from 03.02.20–14.03.20 and can be compared with the original baseline data set. Data was collected from 34 patients for the baseline population and 28 patients in Cycle 1. Baseline data suggests that certain medications, such as preload and TEDs stockings were often missed by the admissions team, with only 8.82% of patients receiving 9 pm preload, 17.6% receiving 6 am preload and 38.2% prescribed TED stockings. Following interventions, medication prescriptions by the clerking doctors improved in all parameters, with significant improvements seen with VTE prophylaxis. Induction sessions and accessible guidelines are essential to ensure guidelines are followed and patients receive correct medications on admission. Improving medication prescriptions is vital for medical optimisation prior to surgery and to lower rates of perioperative complications. Clerking doctors responsible for this task should receive correct training and support to ensure this is done correctly.