Audit of ketoprofen prescribing after orthopedic and general surgery

In 1994, we developed a practice guideline which stated that ketoprofen should be used in every adult patient after surgical procedures for which at least moderate pain was anticipated. The dose recommended was 50 mg every six hours i.v. in the operating room followed by oral administration as soon as possible for three days. The purpose of this study was to evaluate the success of the guideline implementation.

In 1995, an audit performed by a research pharmacist assistant under the supervision of the authors analysed prospectively the files of patients scheduled for orthopedic or general surgery during a one-month period. The compliance of the nurses was also recorded.

Of 185 patients operated upon during the period, seven were transferred to the ICU and were not evaluated. Ketoprofen was not prescribed to 112 (63%) of the 177 remaining patients, either because minor pain was expected (n = 55) or because one or several contra-indications to its use were detected. In cases where ketoprofen was used although theoretically contraindicated (11%), review of the medical records and interviews of anesthesiologists showed that prescription was guided by a risk/benefit analysis. In 18% of cases, nurses did not administer at least one dose of ketoprofen although medical prescription requested regular administration.

Although the use of NSAIDs is still controversial, implementation by anesthesiologists of a practice guideline introducing ketoprofen for postoperative analgesia was successful and the nursing non-compliance rate to follow written orders was modest.