Authors: (including presenting author): :
Lam CP (1), Chu S (1), Hon SF (1), Lee LN (1), Lok HT (1), Chiu WYP (1) (2)
Affiliation: :
(1) Department of Surgery, Prince of Wales Hospital, (2) Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong
Keyword 1: :
Endoscopic procedures
Keyword 2: :
Medication errors
Keyword 3: :
Patient safety
Keyword 4: :
Anticoagulants
Keyword 5: :
Antiplatelet agents
Introduction: :
Medication-related adverse events following endoscopic procedures have been documented as a significant patient safety concern, particularly with high-risk drugs such as anticoagulants, antiplatelet agents, and complex diabetes mellitus (DM) medication regimes. Improper cessation or resumption can lead to serious complications including gastrointestinal bleeding, thrombotic events, and stroke. With increasing prevalence of endoscopic procedures and growing numbers of patients with multiple comorbidities, safe medication management during the peri-endoscopic period has become increasingly complex.
Objectives: :
1. To develop and implement a standardized clinical pathway for peri-endoscopic medication management in endoscopic procedures. 2. To improve staff compliance with the standardized medication instruction protocol across all endoscopic procedure types. 3. To provide patients and families with clear, standardized medication instructions in both Chinese and English to enhance medication adherence and prevent adverse drug events.
Methodology: :
A multidisciplinary team comprising surgeons, ambulatory ward nursing staff, endoscopic nurses, and specialty nurses developed a comprehensive workflow addressing the entire patient journey. The workflow comprised four key phases: (1) Specialist Outpatient Clinic (SOPC) - doctor and specialty nurse counselling and provision of standardized instruction sheets in Chinese and English; (2) Pre-admission - nurse telephone call to confirm patient understanding and medication compliance; (3) In-patient - nursing staff verification of medication status and placement of medication alert cards on patient progress notes; (4) Post-procedure - doctor sign-out with clear documentation of medication resumption instructions. Standardized instruction sheets explicitly listed special medications (anti-diabetic, anti-coagulant, anti-platelet drugs) with clear cessation and resumption schedules. The program was piloted from August to November 2025 across the endoscopic unit, Surgical Ambulatory Ward, and Specialist Outpatient Clinic, with continuous monitoring of staff compliance and patient safety outcomes.
Result & Outcome: :
The implementation of this standardized medication instruction workflow resulted in significant improvements in staff compliance, which increased from 90.61% in August to 96.9% in November 2025, exceeding the 95% target. A post-implementation staff satisfaction survey (n=43) confirmed the program's success, achieving a strong overall satisfaction score of 4.04/5.0. Surgeons demonstrated the highest satisfaction (4.89/5.0), indicating strong leadership buy-in. Staff reported high confidence in their roles (4.26/5.0) and a strong belief that the program improved patient safety (4.14/5.0). Qualitative feedback highlighted the clarity of the instruction sheets and the value of standardized medication listings. The survey also identified areas for improvement, including the need for consistent form completion by doctors and further optimization of the form design. In conclusion, this quality improvement initiative, initiated by the Department of Surgery at Prince of Wales Hospital, demonstrates that systematic, multidisciplinary approaches to standardizing medication instructions can significantly enhance patient safety in endoscopic procedures. By addressing a recognized vulnerability in the field, we have created a replicable, evidence-based framework that can protect patients across departments and hospitals throughout the Hospital Authority.
