Cardiac Surgeon Dalhousie University Halifax, Nova Scotia, Canada
Background: Guidelines suggest all vascular surgery patients should be discharged on antiplatelet and statin medications unless contraindicated, however, compliance varies across hospitals. The purpose of this study was to assess the impact of a multi-faceted, targeted, quality improvement program on compliance for discharge with antiplatelet and statin prescriptions at our institution.
METHODS AND RESULTS: We employed the DMAIC (Define, Measure, Analyze, Improve, Control) methodology, a Six Sigma strategy for improving existing processes to implement a multifaceted program to improve medication compliance for antiplatelets and statins at discharge by addressing barriers at patient, staffing and organizational levels. Organizational changes included prioritizing medication reconciliation of patients undergoing procedures that are likely to be discharged the same day, training designated project champions on the importance of medication compliance, and new standard documentation on discharge summary. Patient interventions included informational posters on the importance of discharge medication with an embedded QR code linking to a video on the same topic. Staffing interventions included reminders affixed to identification badges as well as the provision of education sessions at the nursing and prescriber level. The local Vascular Quality Initiative database was queried and rates of discharge with antiplatelet and statin were compared from 2022 to 2023, before and after implementation of our quality improvement program. Proportions of compliance with best-practice guideline medications were compared between January – December of 2022 (pre-implementation) and January – December of 2023 (post-implementation) using chi-squared test.
A total of 385 patients were included, 330 from 2022 and 223 from 2023. Prescription compliance rates in 2022 demonstrated room for improvement, particularly for endovascular aneurysm repair (EVAR) patients. Rates of medication therapy on admission were similar across both time periods. After program implementation, antiplatelet and statin therapy discharge rates increased across all groups, most notably in EVAR procedures (80% vs 95%, p=0.016). Overall, antiplatelet discharge compliance rose from 95% to 98% (p=0.592), statin discharge compliance rose from 94% to 99% (p=0.008), and overall discharge compliance on combination therapy increased from 84% to 97% (p=0.025) (Table).
Conclusion: A multifaceted education program addressing patient, nursing and prescriber awareness of the importance of antiplatelets and statins on discharge can improve medication prescription rates.
