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BMJ Qual Improv Report 6: doi:10.1136/bmjquality.u211402.w6306
  • BMJ Quality Improvement Programme

Early Aspirin administration post Coronary Artery Bypass Graft Surgery – Changing hospital culture through a two-cycled audit

  1. Justin Ratnasingham
  1. Liverpool Heart and Chest Hospital, United Kingdom
  1. Correspondence to Shefali Parikh shefalipp90{at}gmail.com
  • Received 4 August 2016
  • Revision requested 28 October 2016
  • Revised 17 November 2016
  • Published 10 March 2017

Abstract

“Early Aspirin” or a medium dose of aspirin 6 hours after Coronary Artery Bypass Graft (CABG) Surgery is strongly recommend by international guidelines (EACTS 2007/AHA 2011 guidelines, Level1a evidence) to protect venous graft patency. However, compliance with Early Aspirin prescription at our centre is poor due to long standing hospital cultural practices and lack of awareness.

We completed a two-cycled retrospective audit of 53 (September 2015 Baseline), 65 (January 2016 First Cycle) and 58 (June 2016 Second Cycle) consecutive CABG patients. Interval interventions included educational presentations, educational leaflets/posters, pharmacy liaison and modifications to e-prescription order-sets. Medical, nursing and pharmacy staff were involved in the audit strategies. Early aspirin prescription improved from 23% to 48% to 55% while administration of Early Aspirin improved from 17% to 38% and finally to 48% by second improvement cycle. Significantly, the proportion of patients with omission of early aspirin despite a clear clinical indication, decreased by 50% over the audit period. Important practical considerations were the last dose of anti-platelets preoperatively and amount of of bleeding from mediastinal drains post operatively. A multidisciplinary team based approach led to a 139% improvement in prescription and 182% improvement in administration of “Early Aspirin” after CABG surgery.

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