EP 420 A Tour of ERAS Prescribing Habits in Free Flap Breast Reconstruction
Martyn Eckersley, Hannah Hood, Raksha Naik, Giovanni Ferrara, Russell BramhallAbstract
Introduction
Enhanced recovery after surgery (ERAS) is a multimodal perioperative care protocol to standardise management. In our facility, an ERAS protocol is used for eligible patients undergoing free flap breast reconstruction. The recent move to an ePrescribing system facilitates the auditing of perioperative prescribing in addition to establishing prescribing protocols and improve compliance with the ERAS pathway.
Method
A single-centre, multi cycle closed-loop audit investigating ERAS prescribing of breast reconstruction patients was performed. We assessed whether medications were correctly prescribed as per protocol whilst inpatient and on discharge over three, 3-month periods. After the first round of data collection, a poster was be displayed on the wards. Following this a prescribing protocol was introduced, which was followed by further audit of compliance.
Results
In the first, second and third cycles 31, 41 and 43 patients were identified respectively. For inpatients, a sustained improvement in laxative prescribing from 19.4 to 73.9% was identified, Thromboemoblism stocking prescribing improved 6.5 to 64.3%, whilst Analgesia, anti-emetic and Enoxaparin was reassuringly 100% in all three rounds of the audit. On discharge, Laxido prescribing improved from 12.9% to 59.6%. Anti-emetic, analgesia and Enoxaparin was >95% for all three rounds.
Conclusions
A poster and education programme demonstrated an improvement in compliance with an ERAS protocol in a busy centre, and further improvements were achieved using an eprescribing protocol. Engagement with the wider team beyond resident doctors, including anaesthetists, pharmacists and ward nurses is key to safeguard lasting improvements.