407 Peri-Operative Usage of Proton Pump Inhibitors (PPIs) in Cardiac Surgery: A 3-Cycle Audit Reflection

Aim PPIs reduce gastric ulceration after cardiac surgery; thus patients should receive it the day prior and of surgery. GI protection should continue until patient is eating and drinking, unless on DAPT and continued until discharge. Discharge letter should clearly state the indication and duration for prescribed PPI where patient is on DAPT. The aim of this 3-cycle audit study was to results to see if our recommendations improved compliance. Method Three cycles of data were collected from sequential patients where patient in-patient notes, drug charts and discharge letters were reviewed – first round (n=50, Oct 2019 - Jan 2020), second round (n=51, Dec 2021), third round (n=50, Jan to Jun 2023). Results Across 3 cycles, patients prescribed PPI preoperatively were 96%, 100% and 86% respectively. The data across 3 cycles showed that once drinking and eating, patients discontinued from PPI were 25%, 6% and 19% with continuations documented in 38%, 12% and 38% cases. 100% patients on DAPT were continued on PPI and after discharge with 87%, 68% and 62% having indication and duration for the PPI prescription documented in the discharge letters over 3 cycles. Conclusions Data over 3 cycles showed non-adherence to the standards persisted across most domains despite recommendations of team reminders of PPI protocols. This can be contributed to action-based errors in recording n drug charts as universal/standard documentation practices were not used. These could be mitigated by including guidelines on tick-box-checklists preoperatively, at ward rounds and discharge letters. This would be more time-effective, ultimately leading to better compliance.