Aim The aim of this audit was to examine whether the continuous intravenous infusion prescription chart is an accurate reflection of the infusions the baby is actually receiving. The neonatal continuous infusion prescription charts were redesigned six months ago to reduce the prescribing burden of rewriting all continuous infusions on the Neonatal Intensive Care Unit (NICU) on a daily basis. On the new charts the prescription remains valid until it is crossed off or for a maximum period of 7 days. The impression of the pharmacist however is that prescribers are not always crossing off the prescription when they stop an infusion.
Method Data collection commenced in June 2017 by the Lead Neonatal Pharmacist. All babies on NICU on a Monday for a period of 4 weeks were included. The continuous infusion prescription chart was compared to the continuous infusions actually being administered to each baby and the corresponding numbers recorded. Any prescriptions identified that were no longer being administered but had not been crossed off were marked as ‘inactive’ by the pharmacist and the nurse/prescriber made aware. The results were fed back the same day to the nurses/prescribers on shift by the pharmacist and cascaded to the Lead Neonatal Consultant for Medication Safety and Chair of Drug and Therapeutics Committee for dissemination to the wider neonatal team via email.
A poster was designed and displayed on the ward to highlight the results.
Results Week 1–107 infusions prescribed; 60 being administered (47
(44%) inactive prescriptions)
Week 2–27 infusions prescribed; 21 being administered (6 (22%) inactive prescriptions)
Week 3–26 infusions prescribed, 24 being administered (2 (8%) inactive prescriptions)
Week 4–23 infusions prescribed, 20 being administered (3 (13%) inactive prescriptions)
Conclusion The continuous intravenous infusion prescription chart was not an accurate reflection of the medications a baby was actually receiving at the start of the audit; 44% of infusions prescribed were no longer being administered. The number of prescriptions crossed off when the decision was taken to stop the infusion improved throughout the 4 week period. By week 3 the majority of continuous infusion prescription charts matched the medications the baby was actually receiving. Both the infusions identified as inactive in week 3 and 2 out of the 3 infusions in week 4 were inotropes that had been slowly weaned to stop following the decision to stop on the ward round. These prescriptions were unable to be crossed off at the time the decision was made to stop the infusion, as the intention was to wean to stop; however the nurses informed the pharmacist conducting the audit that the prescribers were aware the infusions had now stopped and were due to come back and cross off the prescriptions.
This audit demonstrates that a regular pharmacist presence highlighting issues with prescribing practice can drive change quite quickly and promote compliance with good prescribing procedures. Training has been incorporated in to the doctor induction programme and neonatal nurse training. The plan is to repeat the audit monthly to ensure compliance is maintained.
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