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 Salvadore DOI: 10.1211/PJ.2013.11118573

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Popular Medicines

    An illustrated history of some of the most popular branded medicines. Includes colourful historical adverts and details of the medicine's formula and intended purpose.

  • Sport and Exercise Medicine for Pharmacists

    All the information you need to provide patients with evidence-based advice on sports and exercise related health matters.

  • Complementary and Alternative Medicine

    A practical reference source on alternative and complementary therapies. Enables healthcare professionals to give knowledge-based advice.

  • FASTtrack: Complementary and Alternative Medicine

    A quick-start guide to all the main types of Complementary and Alternative Medicine, providing both theoretical and practical information.

  • Traditional Medicine

    Covers the major traditional medicine systems. Gives information on philosophy, practice, safety, evidence and examples.


Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete

Supplementary information

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.