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Reducing missed medicine doses in preoperative surgical inpatients

By David Chalkley and Jon Beard


To decrease the frequency of missed medicines doses in preoperative general surgical patients.


Common change management techniques (process mapping, “plan, do, study, act” testing) were used. Four interventions were tested and implemented: clarification of the meaning of “nil by mouth”; nurse education; introduction of a policy summary card carried by all ward staff; and direct challenge to policy deviation.  

Outcome measures

“Missed dose” data were collected daily from five randomly chosen patients. Instances of inappropriately withheld doses or blank administration entries were recorded as failures of existing policy.


Baseline data showed 13.3% of patients (SD 7.6%) experienced one or more inappropriately missed doses each day. Following implementation of three interventions this fell to a mean of 4.8% (SD 4.0%). After implementation of the last intervention it fell to 1.4% (SD 2.6%) ; a relative reduction of 90%. This was maintained thereafter.


Simple interventions designed to increase adherence to existing hospital “surgical nil by mouth” policy were highly effective and sustainable. Apart from the cost of printing a credit card-sized policy summary card, no additional costs were incurred.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11118573

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