Summary of COVID-19 medicines guidance: Surgery

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and surgery.

This page has been put together rapidly in relation to the COVID-19 pandemic.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NHS England/NHS Improvement: Management of general surgical patients

Published 16 March 2020

  • Consider medicines management implications of moving more surgical procedures from inpatient to day cases, use of virtual clinics, moving post-operative patients who would normally be managed in a critical care setting to a less high dependency area and extending to a 7-day service.
  • Consider how pharmacy can help expedite treatment to avoid preoperative delay and minimise length of post-operative stay.
  • Consider how to facilitate non-operative care (eg biliary colic) if that avoids hospital admission.
  • Ensure you have contingency plans for supply chain issues.
  • An anaesthetic guideline for patients requiring surgery and who are positive for Coronavirus will be required.

NHS England/NHS Improvement: Management of cardiothoracic surgery patients

Published 20 March 2020

  • See General Surgical Guidance above

NHS England/NHS Improvement: Management of patients requiring plastics surgery treatment

Published 20 March 2020

  • See General Surgical Guidance above
  • Consider if pharmacy support needed to support any temporary minor operating theatre and dressings clinic that may need to be set up in outpatient areas to allow for suturing of wounds etc.

NHS England/NHS Improvement: Management of vascular surgery patients

Published 20 March 2020

  • See General Surgical Guidance above
  • Consider how pharmacy can support the aim of avoiding in-hospital dressings clinics and facilitate working with community nursing teams to ensure continuity of supply.

NHS England/NHS Improvement: Management of patients requiring spinal surgery

Published 20 March 2020

  • See General Surgical Guidance above
  • Links out to guidance on use of spinal corticosteroid injections (but link currently unavailable)

NHS England/NHS Improvement: Management of patients requiring oral and maxillofacial surgery

Published 23 March 2020

  • See General Surgical Guidance above

NHS England/NHS Improvement: Perioperative care of people with fragility fractures

Published 26 March 2020

  • See General Surgical Guidance above
  • A significant reduction in the incidence of hip fracture is not anticipated and therefore likely that normal levels of service will be required
  • Regional blocks should be offered to all relevant patients. This may help reduce opioid requirements and workload for staff. Use of regional or spinal anaesthesia may beneft the patient, have a positive impact on theatre throughput and reduce the risk of aerosol generation

NHS England/NHS ImprovementManagement of major trauma patients

Published 27 March 2020

  • In terms of blood management – major trauma haemorrhage is protected from all but the most extreme shortages, and as far as possible hospitals should manage patients according to current guidance

NICE:  COVID-19 rapid guideline: haematopoietic stem cell transplantation

Published 1 April 2020

  • Be aware that patients having haematopoietic stem cell transplantation are immunocompromised and may have atypical presentations of COVID‑19. Symptoms of COVID‑19, neutropenic sepsis and viral pneumonitis may be difficult to differentiate at initial presentation.
  • Advice on timing stem cell transplants in patients and donors with COVID-19 and on shielding and protecting transplant donors/recipients pre and post transplant are provided.

 

Royal College Surgeons EnglandRecovery of surgical services during and after COVID-19

Updated 26 May 2020

Provides an overview of considerations that should be part of any decision to resume elective surgery services. A checklist and risk assessment tool is also provided . Nothing specific on medicines or pharmacy services.

 

Royal College Anaesthetists: Restarting planned surgery in the context of the COVID-19 pandemic

Published 1st May 2020

This document structures considerations relevant to the return to planned surgery in four broad categories: Space, Staff, Stuff (equipment) and Systems (the four S’s). Within each category, preparedness for a return to activity is RAG-rated, ie Red (not ready for a return), Amber (close to being ready for a return) and Green (ready for a return). Shortages of key medicines is categorised as red (not ready for a return) and adequate supplies but uncertain supply chain is categorised as amber (close to ready for a return).