7 Surgery

Question 1

Barriers and opportunities for pharmacists in surgery

Answer 1

1. Many teams on surgery ward.
2. Lack of interest in medication related issues
3. Cost effective med use
4. Education and training role on medication related surgical issues

Question 2

Elective patient pathway

Answer 2

1. Patient sees GP
2. Referred to surgical outpatient appt. Decision made for surgery.
3. Pt seen a pre-op assessment a few weeks before.
4. Day of surgery pt arrives 7.30am

Question 3

When is consent obtained

Answer 3

usually by the surgical anesthetist on the morning of surgery

Question 4

Pre-op assessment usually done by …..

and involves….

Answer 4

nurse

Question 5

Pre-op assessment usually done by ….. when….

and involves….

Answer 5

nurse a few weeks before surgery

Procedure explained and questions.
If high risk seen by anesthetist.

Prescribing warfarin bridge therapy and PPIs for pt at risk of GORD

Question 6

Info gathered in pre op (6)

Answer 6

1. Medication and medical Hx
2. Blood tests (eGFR,Hb - need to know if anemic)
3. Weight (important for dosing)
4. BP (may need treatment before op)
5. Blood gluc/HbA1c
6. MRSA screen and eradication

Question 7

Who does the pt see on the morning of surgery (3)

Answer 7

Pharmacist - write up med chart, verify recent changes. This is new in RUH only

Surgeon

Anaesthetist

Question 8

What is missing from the process

Answer 8

• no specialist medication check on morning of surgery (have the correct meds been withheld etc)
• A completed med chart for administering post op
• Drowsy pt cannot confirm regular meds

Question 9

What is missing from the process (3)

Answer 9

• no specialist medication check on morning of surgery (have the correct meds been withheld etc)
• A completed med chart for administering post op (drowsy pt cannot confirm regular meds)
• plan for discharge

Question 10

Problems with dosset box?

NOAC?

Answer 10

Patient cant be expected to stop just one table?

Not recognised as an anticoagulant

Question 11

What is the new process to ensure there is a meds chart

Answer 11

junior doctor writes on pre-op and the pharamcist verifies it with the pt in the morning

Question 12

Ideal world pharmacist provides:

4

Answer 12

Accurate med history
Allergies
Instructions on what to take on day of surgery
Discharge plan

(continuity as doctors frequently rotate)

Question 13

NBM how many hours before

Answer 13

6 - to avoid aspiration of stomach content.

Some meds should still be taken such as antiepileptics

Question 14

General rule on what meds should be given on day of surgery

Answer 14

All reguolar medications (except anticoagulants and oral hypogylcemics) should be given on the day with small sips of water

Question 15

9 pre-op drugs to consider

Answer 15

Warfarin
Antipatelets
Cardiac medicines

Steroids
Insulin/oral hypogylcemics

OC
Tamoxifen

MOAIs
Li