Coordination of OR Medication Prescribing, Preparation and Delivery for Thoracic Transplant Patients

Introduction: Thoracic organ transplantation involves complex intraoperative care requiring timely administration of immunosuppressants and antibiotics. Delays in prescribing, preparation, and delivery of these medications can compromise graft viability and patient safety. This study aimed to create an integrated, agile workflow to ensure accurate, prompt, and reliable medication management by addressing system gaps and improving collaboration, enhancing safety, and reducing delays.


Methods: This single-center, before-after study involved adult heart and/or lung transplant patients. A multidisciplinary team of transplant providers, anesthesia, pharmacists, and nurses conducted a workflow analysis to identify process gaps, communication breakdowns, and timing inefficiencies. Selected interventions included the development of an operating room (OR) medication workflow process addressing real-time communication protocols, education to pharmacists on utilization of advanced preparation reports, and creation of an OR medication table that defines location of preparation and administration. Metrics were collected between 2021-2025, pre- and post- intervention.


Results: There were 382 patients in the pre-intervention group and 839 patients in the post-intervention group. Key metrics such as time of verification prior to medication release, time from release to verification, and time from scheduled OR time to medication administration were tracked and compared to baseline data. Results showed an improvement in verification of medication prior to release (i.e., increased usage of advanced prep reports) from 2% to 28%. The average time from medication release to verification decreased (59 minutes to 31 minutes) and accuracy of timely medication administration prior to OR time improved from 5 hours to 1 hour. These improvements occurred without increasing the number of medications re-dispensed.


Conclusions: Proactive coordination across anesthesia, pharmacy, and nursing teams can substantially improve the reliability and efficiency of medication delivery and administration for thoracic transplant patients. This model may serve as a scalable framework for other high-acuity surgical services requiring complex perioperative medication management.