Tasmin Preston, MPharm student, Keele University
Dr Simon White, Reader in Pharmacy Practice, Keele University @CPD4ALL
Richard Lewis, Advanced Clinical Pharmacist, Royal Stoke University Hospital
Dr Ruth Bednall, Assistant Director for Quality Improvement, Royal Stoke University Hospital
The UKCPA Handbook of Perioperative Medicines was first published in paper form in 2016 with the aim of creating a resource for medical professionals from across the country to access when looking for information regarding medication management during the perioperative period.
Not all hospitals in the UK have perioperative pharmacists, so by releasing the Handbook the UKCPA aimed to “provide national guidance to professionals working in this area of medicine” and to “ensure unified practice for the management of patients’ regular medicines in the perioperative period”.
In 2019 the Handbook moved online to become more accessible. It contains a series of monographs about classes of medicines. Within the monographs there is information about specific medicines with sections on issues for surgery, advice on whether to stop or continue medication during the perioperative period and interactions with common anaesthetic agent and other common medication used in the perioperative period. Users can also search for specific medication or condition monographs.
An evaluation of the Handbook was recently completed during December 2020 and January 2021 using both a questionnaire survey of users and an analysis of Google Analytics to show how the Handbook was being used on the website.
Global and multiprofessional use
Data shows that the Handbook is being accessed by up to around 250 users per day, with most visits occurring during the week and with users spending an average of around three minutes on the site.
The Handbook is mostly accessed from the UK. Outside of the UK, the highest number of users come from Australia, followed by Ireland and USA. Users from many other countries across the globe including Malaysia, Iceland, Turkey and France are also accessing the Handbook.
Nearly two-thirds of users who completed the questionnaire were pharmacists, but other health professionals including doctors and nurses also accessed the Handbook. Unsurprisingly, the vast majority of users worked in a hospital setting.
Information sought in high risk areas of practice
The most accessed monographs on the Handbook website contained information on Direct Oral Anticoagulants (DOACs) and ACE inhibitors, Angiotensin II Receptor antagonists and Angiotensin Receptor Blockers (ACEi, AIIRa and ARB’s). This could be expected as there is a high risk surrounding anticoagulants as they can significantly increase the risk of severe bleeds, and there is an increased risk of a major adverse cardiovascular event if particular medications are either stopped or continued perioperatively. The high use of monographs in these areas reflect the risks and therefore the need for information. Monographs on metformin, NSAIDS and COX-2 inhibitors, and calcium channel blockers were also popular.
The Handbook can provide information to other healthcare professionals when there is no pharmacist present
Users came across the Handbook in many different ways, including references in other documents or websites, but many had found the resource through either a recommendation from a colleague or through searching for information on the internet.
On a ten-point scale of how easy the Handbook was to use (with 1 being very difficult), over two-thirds of respondents rated it 5 or above. Similarly, almost three-quarters of respondents rated the Handbook as 5 or above when asked if it was a useful addition to their resources and 95 percent would recommend it to others.
Unifying care and reducing errors
Although this study involved a relatively small number of users (which may be due the COVID-19 pandemic and the resulting decrease in elective surgeries), it nevertheless provides useful information to inform the improvement of the Handbook in future revisions.
The Handbook has set out to be a resource to help unify perioperative care and give reliable advice regarding a multitude of perioperative scenarios in one easily accessible place. The Handbook has the potential to help unify perioperative care and reduce errors, not only in the UK but also globally.
Results from this pilot study show that the majority of users are pharmacists in a hospital setting who are looking for resources to help adequately inform them so that they can make decisions in a perioperative setting to reduce potential interactions or complications in medically sensitive situations. In addition, the Handbook can also provide information to other healthcare professionals when there is no pharmacist present. In order for the Handbook to be more effective in its aims to unify guidance, more healthcare professions need to be made aware of it.
The opinions expressed in this article are those of the authors. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.
Competing interest statement:
The authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.