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G217(P) Quality Improvement Project: ‘Safe Prescribing’ in St Georges Hospital paediatric department
  1. M Leach,
  2. L Etheridge,
  3. P Truesdale
  1. Paediatrics, St Georges Hospital, London, UK

Abstract

Aims and objectives To improve standards of safe prescribing based on RCPCH prescribing tool

To reduce prescribing errors to less than 1 per prescription with 3% of errors involving a safety issue.

Assessment

  • June 2013: Analysis of CQUIN data/Datix forms, baseline real time audit of inpatient drug charts

  • July 2013: Analysis of results at governance meeting, production of action plan

Strategy of change/interventions - September 2013

Engaging staff through sourcing ‘Prescribing Champions’ (nurses, doctors, managers, Pharmacists)

Setting standards: developing a ‘Prescribing mat’

- October 2013

Raising awareness of standards through workshops (doctors/nurses), posters in clinical areas, prescribing test for doctors with ‘Certificate’

Contemporaneous feedback via star chart game – sampling of drug charts,

Measurement of change

  • – November 2013: Re-audit of all inpatient drug charts

  • – Sampling questionaire doctors/nurses

Results

  • Baseline audit: error rate of 2.5 per prescription (896 errors per 359 prescriptions). Most common error (61%) incomplete legal requirements, 5% errors potential safety issue.

  • Results of sampling drug charts: reduction in error rate to < 1 after 2 weeks, error rate 1.1 after 4 weeks

  • Re-audit: error rate 2.0 per prescription (606 errors per 305 drug prescription). Most common error (51%) still incomplete legal requirements, 5% errors ptoential safety issues

  • Sampling questionnaire: 10 doctors, 12 nurses, 96% increased awareness, 79% learned standards, 79% more empowered to implement standards.

Conclusion Increase in knowledge through active programme of training supported by sampling and feedback.

However, behaviour change as analysed by prescription error rate showed only small improvement. There was little or no reduction in errors regarding legibility and legal requirements. No change in percentage of safety issues.

Sampling questionaire indicated some change in attitude (empowerment).

Lessons learnt

  • Targeting more specific changes e.g. such as using stamps to meet legal requirements can be more effective than change of ‘all’ standards.

  • More involvement of champions when selecting change

  • Importance to explore barriers relevant to people e.g why people fail to give 2 identifiers for legal requirement.

Next action cycle

  • Targeting two most common errors: Capital letters for clarity and legal requirements (provison of stamps)

  • Exploring barriers and increasing feedback through champions

  • Ongoing sampling to demonstrate progress

  • Ongoing training through workshops/prescribing tests

  • Re-audit February 2014

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