Compliance with pre-operative instructions for procedures with conscious sedation: a complete audit cycle.
BACKGROUND
A wide variety of procedures in all surgical departments are performed under conscious sedation with midazolam. Patients are required to adhere to a list of pre-operative instructions but poor compliance has been noted anecdotally in our department and in the literature. This can lead to delayed and cancelled appointments.


OBJECTIVE
We aimed to audit the compliance of patients in following preoperative sedation instructions in the oral and maxillofacial department of a large tertiary teaching hospital with a view to improving compliance. All patients undergoing conscious sedation for day case procedures in a five month period were audited. We implemented changes based on findings and a literature review, followed by a second eight month period of audit.


RESULTS
Twenty-nine and 30 patients participated in each cycle respectively. In the first cycle over 55% of patients were non-compliant. The most common reasons were not bringing a competent adult escort at the start of the appointment (17% of total) and having consumed alcohol in the 24 hours pre-operatively (17%). Based on this, the patient information leaflet was revised. Patients received copies when being listed and then with their posted appointment letter, as well as being verbally reminded before attending. Second cycle results revealed a 22% increase in compliance rates across all instructions with all patients bringing competent escorts along.


CONCLUSIONS
Efficacy within the NHS is often achieved with simple and practical improvement to clinical and administrative practice. By achieving a reduction in non-compliance rates, the department was able to reduce appointment delays and waiting lists, ultimately to the patients' benefit.
Division of Gastrointestinal Surgery, School of Graduate Entry Medicine and Health Sciences, University of Nottingham Medical School at Derby, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT.
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Ravindra
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Barrett
D000293:Adolescent; D000328:Adult; D016292:Procedural Sedation; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008874:Midazolam; D008875:Middle Aged; D010349:Patient Compliance; D011300:Preoperative Care / Q000379:methods*; D013515:Surgery, Oral / Q000379:methods*
D008874:Midazolam