What we learnt from developing national Perioperative guidelines

Claire and I were both involved in developing the original UKCPA Handbook of Perioperative Medicines and it was something we both enjoyed contributing to and are both proud of. Users of the Handbook told us that it was a fabulous resource, but both Claire and I knew that there was room for development and that it needed to be kept up to date in order to continue gaining support from organisations such as the Royal College of Surgeons of Glasgow and The Preoperative Association. 

So what did I do when my line manager became the new Chair of UKCPA? I chose to seize the opportunity! I secured Ruth Bednall’s support to undertake a full review of the Handbook. 

Assembling the team

I was under no illusions: this project was a big undertaking. I knew it would be something I could not do alone, but that in order to maintain control, ensure consistency and keep to the tight launch deadline, I needed a small team. I approached Claire Frank who I used to work with at Wrexham Maelor Hospital in North Wales and thankfully she agreed to join me. 

Claire and I both have a passion for perioperative medication management. It is an area that we have been heavily involved in throughout our careers, either working directly in pre-operative assessment clinics or in the form of medication management guideline development and advice. Together, we have nearly 20 years’ experience in this area.

We invited the Royal College of Anaesthetists and The Preoperative Association to join us in developing the revised Handbook. This was key to ensure that we had multi-professional input and could count on endorsement from these organisations.

In addition, we also involved key specialists such as Ketan Dhatariya, a Consultant in Diabetes, Endocrinology and General Medicine and contributor to the Joint British Diabetes Societies guideline Management of adults with diabetes undergoing surgery and elective procedures

Putting a plan together

Before starting work on the Handbook, Claire and I defined our vision for the project. Ultimately this was to ensure that patients have evidence-based and consistent care with regards to their pre-, peri- and post-operative medication through widespread adoption of the Handbook throughout the UK. 

In addition, we wanted the resource to be accessible to all the healthcare professionals that a patient may encounter on their surgical pathway: pharmacists, pre-op assessment nurses, ward nurses, anaesthetists, junior doctors and consultant surgeons. We needed a format that would support this aim. The original Handbook was available to purchase in PDF or hard copy format for a small fee but Claire and I firmly believed that, in order to ensure widespread uptake by all healthcare professionals, the new Handbook needed to be free to access. 

The revised Handbook of Perioperative Medicines is the perfect example of what can be achieved with vision, passion and dedication

Originally, we wanted to develop an app but it soon became apparent that this would be too costly. My colleague Richard Lewis, the Electronic Medicines and Digital Optimisation pharmacist at UHNM, suggested that we develop a website at a fraction of the cost which would enable us to make the Handbook accessible and free to any health professional. We presented this vision to UKCPA and they agreed.

Spreading the word

We knew that we would need a robust marketing strategy to let everyone know that the Handbook had been substantially revised and improved. Thanks to the support of UKCPA we secured an exhibition stand at The Preoperative Association conference and the Pharmacy Together conference in November 2019. The UKCPA designed and printed leaflets and posters to promote the Handbook and we quickly learnt how to use Twitter (we have never spent so much time ‘hashtagging’!)

The week of the launch was a blur of travel, meetings, networking and tweeting. But we had a fantastic reception and it was very rewarding to receive such positive feedback, not just from pharmacists but from pre-operative assessment nurses and anaesthetists as well. 


The whole process has been a steep learning curve for both of us, but we have developed professionally and personally throughout the project. Being honest and maintaining regular communication were key to achieving our aims. 

So, what comes next? The Handbook is an ongoing project and we are actively seeking feedback either directly to us or via the website which has a feedback section. We have many plans to develop it further so we are setting up a process for reviewing existing monographs and inviting other interested pharmacist members of UKCPA to be involved. 

Claire and I would not have been able to do this without the dedication and patience of Richard Lewis for website development, the encouragement and support of Ruth Bednall (UKCPA Chair) and the hard work and support of Sarah Carter (UKCPA General Secretary) and Marie Matthews (UKCPA General Manager). 

If you are considering developing guidelines in your field of expertise, the revised Handbook of Perioperative Medicines is the perfect example of what can be achieved with vision, passion and dedication. It takes a lot of hard work, but the UKCPA are the perfect conduit and we should all be encouraged by the success that we have had. 

The opinions expressed in this article are those of the author. 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: financial remuneration and administrative support was received from UKCPA for the revision of the Handbook of Perioperative Medicines; Pfizer and Abbvie provided financial support but were not involved in the content; no other relationships or activities that could appear to have influenced the submitted work.


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