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Flashcards in 7 Surgery Deck (15):
1

Barriers and opportunities for pharmacists in surgery

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

2

Elective patient pathway

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

3

When is consent obtained

usually by the surgical anesthetist on the morning of surgery

4

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

and involves....

nurse

5

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

and involves....

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

6

Info gathered in pre op (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

7

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

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

Surgeon

Anaesthetist

8

What is missing from the process

-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

9

What is missing from the process (3)

-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

10

Problems with dosset box?

NOAC?

Patient cant be expected to stop just one table?

Not recognised as an anticoagulant

11

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

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

12

Ideal world pharmacist provides:

(4)

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

(continuity as doctors frequently rotate)

13

NBM how many hours before

6 - to avoid aspiration of stomach content.

Some meds should still be taken such as antiepileptics

14

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

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

15

9 pre-op drugs to consider

Warfarin
Antipatelets
Cardiac medicines

Steroids
Insulin/oral hypogylcemics

OC
Tamoxifen

MOAIs
Li