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P42 An audit to assess prescribing of paediatric CD TTOs
  1. Ebraheem Junaid,
  2. Audrey Agudetse
  1. University Hospitals of North Midlands NHS Trust


Aim To establish the root cause leading to an increased amount of time spent for a pharmacist to triage a paediatric controlled drug (CD) to take out (TTO) prescription.

Method Mixed methods were used to collect data. Initially, raw data was collected over a period of three weeks to identify any CD TTO’s that required intervention from the pharmacist. We recorded if the correct CD TTO prescription template was being used, number of CD TTO prescriptions, clinically and legally correct and how long it took to complete the triage by the pharmacist (ward or dispensary based). The amount of raw data collected was not sufficient to establish an accurate picture of the problem. For this reason, we also collected data from the paediatric prescribing tests. The open book prescribing tests are completed by all new doctors coming in to the paediatric rotation. This is a scenarios-based test and question 10 of the test asks them to write out a CD TTO prescription using the CD TTO template. The answers to question 10 of the test were then audited.

Results The data that was collected shows that two thirds (67%) of prescribers failed to answer question 10 of the test (CD TTO question). This indicates an issue with CD TTO prescribing and the reasons why they failed to pass the question (i.e. legally and/or clinically incorrect). One of the reasons that may be a factor is the lack of CD TTO prescribing in paediatrics compared to adults (i.e. lack of practice/unfamiliarity). This may reduce their knowledge regarding CD TTO prescription requirements and thus confidence and competence in prescribing practice. It was also established that errors in relation to the dose and frequency were found to be the most frequent, which also suggests a lack of clinical knowledge and/or use of available resources. The causes of this can range from a lack of appropriate training to lack of self-checks and referring to the BNF and/or other prescribing guidelines. Furthermore, the live data (two CD TTOs audited) also showed that 50% of prescriptions written were not written on the CD TTO template, prompting the pharmacist to spend additional time triaging it. On average, it took 40 minutes to triage one CD TTO prescription.

Conclusions Changes are needed to address the issues that were found in this audit. Recommended immediate actions include making prescribers aware of where CD TTO templates can be found and implementing teaching sessions to improve clinical and legal knowledge of prescription writing. In the long term, it is recommended to add the CD TTO template to the back of the Child Health medication chart (like we have for the adult charts at our Trust). We are also considering creating a pocket guide on the correct prescribing of CD TTOs in consultation with doctors, nurses and pharmacists.

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