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.
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
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).
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