Prevention of Administration of Metformin Group Drugs to Diabetic Patients who Undergo CT Scan on the Day and 48 Hours after Contrast Study in Department of Surgery, United Christian Hospital.

Abstract Description

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Authors (including presenting author) :

Lee SL, Wong KY, Ng WF, Siu KY, Wong PS, Lau SY

Affiliation :

Department of Surgery, United Christian Hospital

Introduction :

Computer Tomography (CT) scan with contrast study is a common procedure for patients in our department. However, for patients who are taking Metformin group drugs, contrast media can cause deterioration of renal function and reduce renal clearance of Metformin level in body. This will increase the associated risk of potentially fatal lactic acidosis. Therefore, Metformin group drugs should not be taken on the day and 48 hours after CT scan with contrast study according to the Radiology service guideline. Currently, alert signage was placed on the clipboard of this group of patients when CT scan with contrast study was arranged. Despite this, there were three related medication incidents from May to December 2017 in our department. Current measure was reviewed and enhancement project was initiated since May 2018 to prevent this kind of medication incident.

Objectives :

To prevent medication incident on administering Metformin group drugs to diabetic patients who undergo CT scan on the day and 48 hours after contrast study.

Methodology :

Current practice on prevention of administration of Metformin group drugs to diabetic patients who undergo CT scan on the day and 48 hours after contrast study has been reviewed and the following preventive measures have been initiated: (1)Identify the difficulties in compliance with putting current alert signage on the clipboard of the patient who taking Metformin group drugs undergo CT scan with contrast study. (2)Design alert signage with Metformin group drugs reference list for all IPMOE notepads. (3)Add "DM (Metformin group drugs: Y/N)" under past medical history on nursing handover sheet. (4)Add Metformin group drugs reference list at the back of nursing handover sheet. (5)Design “Metformin Group” signage on bed head trunk for patients taking Metformin group drugs. (6)Prepare all materials for all four surgical wards in early May 2018. (7)Provide briefing to nursing staff in all surgical wards in the middle of May 2018. (8)Conduct a pilot trial for all the above preventive measures in all surgical wards in late May 2018. (9)Review the effectiveness of the above preventive measures by measuring the number of related medical incident after half-year of implementation.

Result & Outcome :

No related medication incident was reported from all surgical wards till early of December 2018 after implementation of these preventive measures. Enhancement project in ward by implementing the above preventive measures can help to prevent medication incident on administering Metformin group drugs to patients who undergo CT scan on the day and 48 hours after contrast study. Way forward: Regular briefing should be provided to promote this enhancement project especially for new nursing staff. Regular evaluation in form of spot check should also be conducted for 100% compliance rate.