title: Improving preoperative medication compliance with standardized instructions.
abstract: BACKGROUND
  Patient medication adherence in the perioperative setting is challenging, and failure to comply with medication instructions has serious clinical consequences. Many factors contribute to medication nonadherence, but a modifiable cause is inadequate physician instruction of patients. Variable formats, language and legibility impede patient-physician communication regarding proper use of medications. We hypothesized that the use of a standardized, electronic medical record (EMR)-derived medication instruction template would improve medication compliance on the day of surgery.
  
  
  METHODS
  As part of an ongoing quality improvement program, our institution surveyed patient's compliance with preoperative medication instructions. A standardized template was then created within the EMR and implemented by all providers in the preoperative evaluation clinic. Compliance with medications on the morning of surgery was then reassessed by preoperative nursing staff for three months shortly after the intervention and again two years later.
  
  
  RESULTS
  Patient adherence to preoperative medication instructions improved significantly immediately after the implementation of the template (from 83.7% to 89.7%, P=0.025). This improvement was also sustained at the two-year follow-up. Although patients' had overall good medication compliance (90% after the intervention), 71% of medication errors were made with medications with significant potential for causing complications (e.g., antithrombotic therapy).
  
  
  CONCLUSIONS
  Use of standardized, EMR-generated preoperative instructions improves patient medication adherence on the morning of surgery. Even with this intervention, medication nonadherence most often involves medications that could seriously interfere with perioperative care.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA - kpfeifer@mcw.edu.
authors.forename: Kurt
authors.initials: K
authors.lastname: Pfeifer
authors.forename: Barbara
authors.initials: B
authors.lastname: Slawski
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Manley
authors.forename: Victoria
authors.initials: V
authors.lastname: Nelson
authors.forename: Mary
authors.initials: M
authors.lastname: Haines
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008508:Medication Errors; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies