Surgical patients more likely to follow medication instructions

This image depicts common medical labels on medication. Credit: J. P. Rathmell

A study in the July issue of Anesthesiology revealed that patients who receive a simple, multicolor, standardized medication instruction sheet before surgery are more likely to comply with their physician's instructions and experience a significantly shorter post-op stay in recovery. These findings are important because surgical patients often fail to follow their doctor's medication instructions for preexisting conditions such as diabetes and hypertension on the day they are having surgery – a costly mistake that can lead to surgery cancellation, complications and longer hospital stays.

"Certain long-term medications should be continued on the day of , and some should be temporarily stopped, but there is no consistency in how receive medication instructions before surgery," said Thomas Vetter, M.D., M.P.H., ASA member and study lead author, Department of Anesthesiology, School of Medicine, University of Alabama at Birmingham. "Physician anesthesiologists are responsible for assessing and optimizing patients' preoperative medications, including maximizing their compliance with physicians' instructions. Our effort to enhance patients' understanding of medication use before surgery is important and can increase patient satisfaction by more actively engaging them in their own health care."

The study compared 519 who were given preoperative medication instructions through traditional methods (annotated or highlighted portions of the patient's electronic medical record, or verbal instructions) and 531 patients who were given a written, standardized preoperative medication instruction sheet, which was presented and verbally reviewed with patients. The instruction sheet listed all of the medications the patient was instructed to take on the day of surgery (e.g., beta-blocker, etc.), the medications the patient should not take (e.g., blood-thinner, etc.), and the medications that could be taken as needed (e.g., opioid, etc.). The instruction sheet included multicolor graphics to further improve patient recall and compliance.

Researchers found that 74 percent of patients who received an instruction sheet were compliant with their medication instructions on the day of surgery, versus 60 percent of patients in the control group. Patients were also less likely to stay in recovery after surgery for more than 90 minutes when an instruction sheet was administered. Interestingly, African-Americans, older adults (over 65) and patients with more than one chronic disease had lower medication compliance, the authors note.

"Physician anesthesiologists and nurse practitioners typically deliver a lot of verbal information to patients preoperatively, often exceeding patients' short-term memory," said Dr. Vetter. "Our findings show that providing patients with a standardized instruction sheet, both written and verbally, with simple language can improve compliance significantly. However, we speculate that a more concerted effort may be required to improve preoperative medication compliance in certain patients such as the geriatric population."

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