INTRODUCTION AND AUDIT RATIONALE AIM

A 50-year-old gentlemanpresented to hospitalwithchronic rhinosinusitisandwasprescribedtopicaldecongestants.

Due to a lack of availability of medication, his condition worsened, his hospitalstaylengthened,and he requiredsinusdrainageprocedures

Thiswas one of manycases in whichENTspecificmedicationswere notdeliveredpromptlyandapatientresultantlysuffered.Afterliaising with thepharmacyservice, we wereinformedthat manyENT medications were notstocked/ordered as apriority on thewards. Thiswasrelated to thefactthatthetheNationalPatientSafetyAgency (NPSA)andSpecialistPharmacyService,whoassesstherisks of delay or omission for drugs or drugclass,noteENT is alow-riskspeciality in terms of drugdelay or omission.

The aim of this project was to examine the extent of the delay in delivery of medications at Northwick Park Hospital and improve the ward availability of critical ENTdrugs.

Definitions

DoseDelay:Dose not givenwithin2hours of timeprescribed

DoseOmission:Dose not administered by the time of the next scheduleddose

(A dosedelay or omission is noted by a 7 on the drugchart at NorthwickParkHospital)

Standard: Drugs should be safely administered as close to the time noted on the prescription with little delay and no omission.

Method

The drug charts of all patients admitted under ENT at Northwick Park Hospital between September and October 2021 were reviewed (n=122 patients). If there was a delay of delivery or omission of a drug it was documented, along with the type of medication, prescribed dose and the length of time taken to the administration of the first dose.

Results

23% of ENTpatients (n=28)admitted to NorthwickParkhaddrugseitheromitted or delayedduringtheirinpatient stay

Themostsignificantdelayexisted in antimicrobialagents. It took 13% of the cohort 30 hours to receivetheirfirst dose of antimicrobialagent. Onepatientwithaskull baseosteomyelitiswaitedthreedaysfor the firstdose of theirtopicalantibiotic. Furthermore, there existeddelays in the delivery of medications in multipleothergroups including steroidsandnasaldecongestants

There was an average of a 25-hour delay for over-the-countermedications.

DISCUSSION: THE RISK OF DELAY

ENTpatientssufferfromamultitude of seriousconditionsthatwhenleftuntreated, can notonlybesightthreateningbutalsolead to complicationssuch as meningitis,neurologicaldeficitanddeath.CertainENTmedications,such as topicalantimicrobialeardrops are paramount in thetreatment of theseconditions in theearlyphasesandalternatives,e.g.oralswitches, are not as effective or evidencebased.Furthermore,certainmedications,such as nasaldouches, are essential in theearly(24-48hr)post-operativeperiod to preventpost-operativecomplications,andtheireffectivenessdeclines as timeincreasesfromtheprocedure.

Take Home Messages

Although considered low risk, certain ENT conditions such as Otitis Externa and Chronic Rhinosinusitis have potential for significant deterioration if early therapeutic intervention is not achieved.

The low-risk stratification of ENT as specialty has contributed to poorer patient outcomes and extended hospital stays for our cohort of patients

Medical and pharmacy staff should review the risk of medications in the context of their patient groups and stratify more appropriatelyparticularly if the hospital has increasing volumes of patients under the specialty