Laffey J G, Carroll M, Donnelly N, Boylan J F
Department of Anaesthesia, St. Vincent's Hospital, Dublin.
Ir J Med Sci. 1998 Jul-Sep;167(3):160-3. doi: 10.1007/BF02937929.
Ambulatory surgery has proliferated as a result of increasing inpatient costs. Its high level of safety has resulted in its extension to less healthy, often elderly patients. Patient compliance with instructions is essential to avoid morbidity. We aimed to identify subgroups potentially at risk due to non-compliance. A confidential questionnaire was administered to 220 consecutive daycase patients. Data included: patient demographics, duration of fasting, taking of medications that morning, importance of fasting and medication instructions, mode of post-discharge transport, and whether they had someone to stay with them that night. Seven (3.5 per cent) patients admitted to non-compliance with fasting instructions, with 8 per cent considering these instructions non-essential. Thirteen of 59 patients on medications took them against instructions, with 9 patients considering the instructions non-essential. Eight patients admitted intending to drive home; 7 per cent admitted to having no one to stay with them on the night of surgery. A significantly minority of patients (particularly male) admit to non-compliance with ambulatory surgery instructions; these figures may be underestimates. Absence of anaesthetic/medical input and lack of reinforcement probably contribute to non-compliance. Some medication-related non-compliance may be appropriate (e.g. antianginals, antihypertensives) and may reflect conflicting instructions given to the patient. The stopping of all medications prior to ambulatory surgery needs revision. Older patients living alone may not be suitable candidates for ambulatory anaesthesia.
由于住院费用不断增加，门诊手术得到了广泛应用。其较高的安全性使得它能够应用于健康状况较差、通常为老年的患者。患者遵守医嘱对于避免发病至关重要。我们旨在确定因不遵守医嘱而可能面临风险的亚组。对220例连续的日间手术患者进行了一份保密问卷调查。数据包括：患者人口统计学信息、禁食时间、当天早晨是否服药、禁食和服药说明的重要性、出院后交通方式以及当晚是否有人陪伴。7名（3.5%）患者承认未遵守禁食说明，8%的患者认为这些说明无关紧要。59名正在服药的患者中有13名未按医嘱服药，9名患者认为这些说明无关紧要。8名患者承认打算开车回家；7%的患者承认手术当晚无人陪伴。相当一部分患者（尤其是男性）承认未遵守门诊手术医嘱；这些数字可能被低估了。缺乏麻醉/医疗指导以及缺乏强化措施可能导致不遵守医嘱。一些与药物相关的不遵守医嘱情况可能是合理的（如抗心绞痛药、抗高血压药），可能反映了给予患者的相互矛盾的医嘱。门诊手术前停用所有药物的做法需要修订。独居的老年患者可能不适合门诊麻醉。
