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Audit of drug prescribing in RHSC

Audit of drug prescribing in RHSC. Catherine McDougall Camilla Stockley, Phui Yee Wong May 2010. Background. Limited evidence suggests medication errors & corresponding harm could be higher in children than adults Prescribing errors are common in paediatric inpatients in UK

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Audit of drug prescribing in RHSC

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  1. Audit of drug prescribing in RHSC Catherine McDougall Camilla Stockley, Phui Yee Wong May 2010

  2. Background • Limited evidence suggests medication errors & corresponding harm could be higher in children than adults • Prescribing errors are common in paediatric inpatients in UK • 13.2% medication orders contained error Ghaleb et al, Arch Dis Child 2010 • Previous prescribing audits at RHSC 2007/8

  3. Objective • To improve safety in drug prescribing by all clinical staff

  4. Methods • All drug charts in use on hospital wards on 23.3.10 assessed using proforma • Allergies confirmed by referring to medical notes or asking parents • Kardex “failed” if any one drug failed on any point • NHS Lothian Medicine Policy (“Golden Rules”) used as audit standard

  5. Patient details BLOCK CAPITALS Black pen Documentation of drug allergies Kardex number if applicable (1 of 2, 2 of 2 etc)

  6. Name & DOB on each page Oxygen prescription Drug name in capitals Units in full, except mg/g/ml Stopping drugs: Vertical + double diagonal lines Sign, print, date Signature + printed name

  7. Minimum time interval between doses, maximum daily dose

  8. Results • 80 drug charts audited • Medical (wards 1,2,6,7): n=34 • Surgical (wards 3,4,5): n=34 • Critical care (PICU,HDU,NNU): n=12

  9. Personal details • Multiple charts appropriately labelled in 8/10 cases (1 of 2, 2 of 2 etc)

  10. Documentation of allergies • Of 29 charts with incomplete allergy information, 5 (17%) children had drug allergies • No identified cases of documented allergy info being incorrect

  11. Drug prescriptions

  12. All drugs prescribed correctly Only 33% drug charts

  13. Discontinuing drugs • Overall, drugs discontinued correctly on 5/51 (10%) drug charts

  14. Prescription of oxygen • 11 patients received oxygen • Only prescribed in 2 cases (18%) • 1/4 medical, 1/7 critical care

  15. Conclusions • Only one third of drug charts were completed according to Medicines Policy • Main problem areas • Use of capitals • Documentation of allergies • Prescriber’s name printed • Minimum interval for ‘as required’ drugs • Discontinuation of drugs • Prescription of oxygen

  16. Completing audit cycle • Dissemination of audit results + raising awareness of prescribing guidelines • “Golden rules” for paediatric prescription writing now issued in induction pack • Prescribing quiz with kardex question • ?alterations to drug kardex • Repeat audit on regular basis

  17. Comments on new RHSC kardex? • Separate section for iv drugs • Minimum interval/indication for PRN drugs • Fewer time slots catherine.mcdougall@luht.scot.nhs.uk

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