Drug utilization study in post operative patients in surgical ward of tertiary care teaching hospital

Background: This study was aimed to evaluate the drug prescription pattern and to analyze the drug usage in post operative surgical patients with appendicitis, cellulitis, diabetic foot ulcer, hernia and hydrocele in tertiary care teaching hospital.Methods: A prospective observational study was conducted over a period of six months in post-operative surgical patients at Mahatma Gandhi Memorial Hospital, Warangal, Telangana, India, which was approved by Institutional Ethics Committee. The data obtained was analyzed using graph pad prism 7.0 and the conclusions were drawn using descriptive analysis.Results: A total of 429 cases were recruited during the following study period of which, parenteral drugs were pantoprazole 399 (93%), ceftriaxone 319 (74.35%), metronidazole 239 (55.71%). Oral drugs were multivitamin 400 (93.24%), serratiopeptidase 299 (69.69%), voveran 162 (37.76%). Majority of the drugs prescribed were intravenous fluids, antacids, antibiotics, analgesics were accounted. The percentage encounters with generic drugs was 99% in present study.Conclusions: The present study provides valuable insight about the overall pattern of drug use profile in postoperative patients in the surgical unit of a tertiary care hospital. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society. The prescribing pattern was according to the National Essential Drug List is very low and needs improvement.

Drug prescribing pattern in surgical wards of a tertiary care hospital in Western part of India

Background: In surgical wards, drugs are required to manage pain, nausea, vomiting, infections, etc. A growing number of pharmaceutical products are available in present era. Irrational prescribing of drugs is prevalent worldwide. Drug utilization study can be used to assess prescribing patterns. Authors undertook this study to determine current practice of prescribing in surgical wards of the hospital.Methods: Authors conducted observational, noninterventional, descriptive study among patients admitted in surgical wards for one year. Authors have analysed collected data of 604 patients using descriptive statistics to determine utilization pattern of drugs and drug use indicators.Results: Appendicitis (14.9%) followed by hernia (10.6%) were leading diseases for admission. Mean duration of stay was 7.44. Average number of drugs in a prescription was 8.94. Antibiotics (32.07 %), analgesics (17.11 %) and antacids (16.09 %) were leading drug groups prescribed. Amikacin (5.81 %) followed by metronidazole (5.30 %) and ciprofloxacin (5.19 %) were commonly prescribed antimicrobial drugs. Tramadol (5.31 %) and pantoprazole (7.17 %) were leading drugs prescribed from analgesics and antacids respectively. All prescriptions had at least one injectable drug. At least one antibiotic was present in 92.05 % prescriptions. Majority of drugs (87.27 %) were prescribed by generic names. Proportion of drugs prescribed from essential medicine list was 84.22 %.Conclusions: Polypharmacy and injectable drug prescribing were common in practice. There is a scope for improving such prescribing practices among practitioners. Use of multiple antibiotics should be avoided whenever possible and usage should be evidence based.

Clinicopathological Study of Peptic Perforation was Carried Out in 150 Cases Admitted in Surgical Wards of Sanjay Gandhi Memorial Hospital Associated with Shyam Shah Medical College, Rewa (Madhya Pradesh).

Background: Peptic ulcer disease (PUD) is a common disorder that affects millions of individuals each year. PUD has a major impact on our health-care system by accounting for roughly 10% of medical costs for digestive diseases. Overall, peptic ulcer mortality and hospitalization rates have declined for the past two decades, but complications such as peptic ulcer perforation and bleeding remain a substantial health-care problem. Materials and Methods: It was a prospective 1-year study conducted in all cases of peptic perforation admitted in surgical wards during the study period August 2013-July 2014. On admission, every patient was interrogated about name, age, sex, address, occupation, religion, and residence. All patients suspected of peptic perforation with symptoms of the sudden onset of epigastric pain in abdomen, distention of abdomen, constipation, and vomiting were admitted to surgery ward from the outpatient department or transferred from other wards. Their findings were recorded in a pro forma and master chart. The information obtained was tabulated and analyzed. Results: Incidence of peptic perforation was 1.65% of all surgical admissions. It was 6.63% of total case of acute abdomen and 50.17% of total case of perforation peritonitis. A maximum number of peptic perforation cases was found in age group 51-60 years (24.67%). Conclusion: Perforation of the peptic ulcer is due to the persistence of causative factors of peptic ulceration with a decrease in mucosal resistance due to injudicious use of corticosteroids, decreased immunity, malnutrition, delay in hospitalization due to initial treatment by homemade medicines and abdominal massage further complicates the perforation in this region. Peptic perforation is diagnosed on clinical grounds and abdominal X-ray easily, yet due to delayed hospitalization and time consumed in resuscitation of the patient affects the outcome of standard surgical procedure.

"By the ""high quality nursing service demonstration project"" as a turning point, exploring the application of implementing accountability nursing mode in pediatric surgical ward" / 中国实用护理杂志

Objective To explore the application effect of implementing the accountability nursing mode in pediatric surgical ward.Methods On the basis of the transformation of nursing concept and the improving of understanding of High Quality Nursing Service Demonstration Project activities,strengthening basic nursing,establishing two-level nurse management framework,implementing the accountability nursing mode.The satisfaction degree of children's parents before and after the implementation was compared.Results The satisfaction degree of children's parents after the implementation of accountability nursing mode significantly improved.Conclusions After implementing accountability nursing mode in pediatric surgical ward,the satisfaction degree of children's parents improved,the harmonious development of nurse-patient relationship was promoted,the professional identity of nursing personnel was enhanced,and guaranteed the continuous improvement of quality of care.

Evaluation of preoperative undernutrition, nutritional risks, and nutritional support in general surgical wards / 中华临床营养杂志

Objective To evaluate the preoperative undernutrition, nutritional risks, and nutritional support in general surgical wards. Methods The nutritional risks of 217 new in-patients in general surgical wards in a Beijing-based hospital were assessed using nutrition risk screening 2002 ( NRS 2002 ) and the medical records were reviewed. Results The overall prevalence of preoperative undernutrition and nutritional risks was 7.4% and 14.7% respectively, most of which occurred in patients with gastrointestinal diseases and malignant diseases. Nutritional supports were provided to 18.8% of patients with undernutrition, 12.5% of patients with nutritional risks,3.0% of patients without undernutrition, and 2.7% of patients without nutritional risks. The enteral nutrition:The application of nutritional support should be further improved in general surgical wards.

Survey on and analysis of pre-operative nutritional risks and nutritional supports among patients and related knowledge among surgeons in general surgical wards / 肠外与肠内营养

Objective: To assess the relationships between nutritional risks, nutritional support, and doctors' knowledge related to nutritional risks. Methods: 217 pre-operative patients and 41 doctors in the same general surgical wards were surveyed by using NRS2002 and self-developed questionnaires in a Beijing hospital. Results: The overall prevalence of pre-operative nutritional risks was 15.7%. Patients with gastrointestinal and/or malignant diseases had higher risks than others(P values were both less than 0.001). The nutritional support rates were 14.7% among patients with nutritional risks, and 2.2% among those without risks. The EN: PN ratio was 1∶ 2. A majority of doctors had misconceptions in nutritional risk screening and the effectiveness of nutritional supports. Their clinical practices were not consistent with their knowledge. Related trainings were required. Conclusions: Patients with gastrointestinal and/or malignant diseases have higher possibilities of nutritional risks. The nutritional supports rates are generally low. Doctors' knowledge related to nutritional risk screening is insufficient. More training opportunities are suggested to enhance the application of NRS2002 and appropriate nutritional supports.

Dimensionamento de pessoal de enfermagem em centro cirúrgico no período transoperatório: estudo das horas de assistência, segundo o porte cirúrgico / Dimensioning of nursing staff in a surgical center during the transoperative period: study of care hours, according to surgical size

A presente pesquisa foi desenvolvida com a finalidade de apresentar um modelo de dimensionamento de pessoal de enfermagem para o período transoperatório, possibilitando aos enfermeiros determinar, com maior precisão, a quantidade de pessoal necessário para assegurar a qualidade da assistência de enfermagem no Centro Cirúrgico. Esse modelo foi desenvolvido considerando as seguintes variáveis: quantidade de cirurgias eletivas e de urgência/emergência, segundo o porte cirúrgico, especialidades médicas e o tempo médio de utilização da Sala de Operação; horas médias de assistência de enfermagem; produtividade da equipe; tempo médio de limpeza da Sala de Operação e ausências previstas e não previstas da equipe de enfermagem. A aplicação do modelo proposto, em um Centro Cirúrgico de um hospital de ensino, possibilitou analisar os seguintes resultados: com relação ao movimento cirúrgico, o maior número de cirurgias eletivas, bem como de urgências/emergências foi a porte II (42,5%), seguido de porte I (31%), porte III (15,5%) e porte IV (10,8%). O tempo médio do intraoperatório das cirurgias eletivas foi de 196,7 minutos (3,27 horas) e de urgências/emergências de 213,1 minutos (3,55 horas) A especialidade médicas que apresentou maior número de cirurgias eletivas foi a Urologia com 982 (14,8%) cirurgias, seguida da Oftalmologia com 958 (14,5%) cirurgias. Nas cirurgias de urgência/emergência, a especialidade médica Cirurgia de Emergência foi a que mais operou com 863 (49,1%) cirurgias, seguida da Cirurgia Vascular com 358 (20,4%) cirurgias. O tempo médio de limpeza das Salas de Operação das cirurgia eletivas foi de 31,8 minutos e das cirurgias de urgência/emergência 40,8 minutos. O tempo médio de assistência de enfermagem, durante o período intraoperatório das cirurgia eletivas, segundo o porte cirúrgico, foi de 6,54 horas, ) assim distribuídos: 2,88 horas para o porte I; 5,76 horas para o porte II; 9,80 horas para o porte III e 16,72 horas para o porte IV. Para as cirurgias de urgência/emergências, o tempo médio de assistência de enfermagem, segundo o porte cirúrgico, foi de 7,10 horas, assim distribuídos: 2,56 horas para o porte I; 5,86 horas para o porte II; 9,82 horas para o porte III e 17,26 horas para o porte IV. O quadro de pessoal, segundo as equações desenvolvidas, resultou em 101 profissionais, abrangendo: 16 enfermeiros e 85 auxiliares de enfermagem. Acreditamos, com este estudo, estar contribuindo para a composição do quadro de pessoal de enfermagem para o período transoperatório, mais próximo à realidade, evitando sobrecarga de serviço ou a contrário, ociosidade de pessoal

This research was developed with the aim of presenting a model of calculating and distributing the nursing personnel required for a transoperatory period, thereby enabling the nurses to determine with more accuracy the number of personnel necessary for assuring a good quality of nursing assistance in the Surgical Center. The following variables were taken into consideration for working out this model: quantity of planned surgeries and of urgency/emergency; type of surgical extent; medical specialties; average time of use of the Operating Room (OR); average time of nursing assistance; team productivity; mean time for cleanig the OR; foreseen and not foreseen absences of the nursing team. The application of the proposed model in a Surgical Center of a teaching hospital enabled the analysis of the following results: regarding the surgical turnover, the higher number of planned surgeries as well as of urgency/emergency was of extent II (42,5%), follwed by extent I (31%), extent III (15,5%) and extent IV (10,8%). The intraoperatory mean time of the planned surgeries was 196.8 minutes (3.28 hours) and of the urgency/emergency of 212.5 minutes (3.54 hours). The medical specialty which showed the higher number of planned surgeries was Urology with 982 (14,8%) surgeries, followed by Ophthalmology with 958 (14,5%) surgeries. Among the urgency/emergency surgeries, it was the Emergency Surgery speciality that had the greater number of surgeries with 863 (49.1%) surgeries, followed by Vascular Surgery with 358 (20.4%) surgeries. The average cleaning time of the OR in planned surgeries was 31.8 minutes and 40.8 minutes in urgency/emergency surgeries. The mean time of nursing assistance during the intraoperatory period of planned surgeries according to the surgical extent was 6.54 hours, distributed among the various surgical extents as follows: 2.88 hours for extent I, 5.76 hours for extent II, 9.80 for extent III and 16.72 hours for extent IV. In the urgency/emergency surgeries, the average time of nursing assistance according to the surgical extent was 7.10 hours, distributed as follows: 2.56 hours for extent I, 5.86 hours for extent II, 9.82 hours for extent III and 17.26 hours for extent IV. According to the calculations made, the nursing staff comprised 101 professionals covering 16 nurses and 85 nurse auxiliaries. We do hope that with this study we shall be contributing for a more realistic composition of the nursing personnel during the transoperatory period, thereby avoiding overburden of services, or contrarily, inoccupation of personnel