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Frequency of Prescribing and Administering Premedication in Paediatric Surgical Patients at a Tertiary Care Hospital:
Ausaf A Khan1, Durriya Raza1, Muhammad Qamar-Ul-Hoda1
1Anaesthesiology, Aga Khan University Hospital, Karachi, PAK.
Insights
Many pediatric surgical patients did not receive preoperative premedication. When prescribed, details like drug route and timing were often missing, impacting stress and infection management.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Preoperative stress in pediatric surgical patients can lead to negative outcomes like behavioral issues and infections.
- Multimodal approaches, including ward-based pharmacological premedication, are recommended to mitigate preoperative stress.
- This study assessed the prescription and administration rates of premedication in pediatric surgical patients.
Purpose of the Study:
- To determine the frequency of premedication prescription for pediatric surgical patients.
- To evaluate the completeness of premedication orders, including drug, dose, route, and timing.
- To assess the administration and documentation of premedication in the inpatient ward.
Main Methods:
- Retrospective observational study of 125 pediatric patients (1-16 years) undergoing elective surgery.
- Review of preoperative forms and medical records from October to December 2014.
- Data collection focused on premedication orders and administration timing in wards.
Main Results:
- Premedication was not prescribed to 40% of pediatric patients.
- For prescribed premedications, drug and dose were usually specified (98.7%), but route (26.6%) and timing (12%) were often omitted.
- Ward nurses administered premedication in 89.3% of prescribed cases, with documentation in 95.5%, though timing was frequently missing (46.3%).
Conclusions:
- A significant proportion of pediatric surgical patients did not receive prescribed preoperative premedication.
- Incomplete prescription details (route, timing) were common when premedication was ordered for ward administration.
- Gaps in prescription and documentation highlight areas for improvement in pediatric preoperative care.
Introduction:
Preoperative period is a stressful event, especially for paediatric patients undergoing surgery. Stress may lead to the development of perioperative maladaptive behaviour, activation of stress responses, and susceptibility to postoperative infections. To alleviate preoperative stress, the use of a multimodal approach including preoperative pharmacological premedication in the ward is recommended. We conducted an observational study to determine the frequency of prescribing and administering premedication in paediatric surgical patients.
Methods:
This three-month retrospective observational study was conducted in the main operating room of the Aga Khan University Hospital, Karachi, from October to December 2014. It included all paediatric patients (aged 1-16 years) coming for elective surgery. Patients' preoperative forms and medical records were reviewed, and data recorded for written orders of premedication and the timing of administration of the premedication drug in the inpatient ward/surgical day care ward. A p-value <0.05 was considered statistically significant.
Results:
This study included 125 paediatric patients. Premedication was not prescribed to 40% (50/125) patients. In these patients, drug and dose were properly mentioned in 98.7% (74/75) of cases while the route and time of administration were not mentioned in 26.6% and 12% prescription orders, respectively. The premedication drug was administered in 67 out of 75 patients (89.3%) by ward nurses as per prescription. The administration of premedication was documented in 95.5% patients, but the time was missing in 46.3% of cases.
Conclusion:
A significant number of patients were not prescribed preoperative premedication by the anaesthetist. Moreover, the route and timing of administration of drug were not mentioned especially in cases when premedication was prescribed in the wards.
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