Jump to comment:

• Electronically turning the audit cycle wheel to improve prescribing habits
  LIDA PANAGIOTOPOULOU
  Published on: 22 March 2016
• Prescription error: how to manage?
  professor viroj wiwanitkit
  Published on: 22 March 2016

• Published on: 22 March 2016

  Electronically turning the audit cycle wheel to improve prescribing habits

  • LIDA PANAGIOTOPOULOU, ST1 in Paediatrics
  • Other Contributors:
    • Rowena McArtney, David Tuthill

  Dear Professor Bauchner,

  Re: Electronically turning the audit cycle wheel to improve prescribing habits

  Medication errors in paediatrics are acknowledged as common with up to 13% of prescriptions having errors and administration mistakes occurring in up to 19% of admissions.[1]. Safer prescribing is therefore recognised as an important issue and effective strategies to improve it continue to be requi...

  Show More

  Dear Professor Bauchner,

  Re: Electronically turning the audit cycle wheel to improve prescribing habits

  Medication errors in paediatrics are acknowledged as common with up to 13% of prescriptions having errors and administration mistakes occurring in up to 19% of admissions.[1]. Safer prescribing is therefore recognised as an important issue and effective strategies to improve it continue to be required.

  A universal standardised "All Wales inpatient prescription chart" exists [2] in all hospitals throughout Wales. All Wales standards for prescribing on this national prescription chart exist . This national standardisation of medication charts and clear prescribing standards are an endeavour to reduce medication errors; they focus on clear prescribing and have 18 standards. The recent GMC research on medication errors [3] demonstrated an overall error rate around 8.9%. Key suggestions for improvement included undergraduate and postgraduate training and a standard UK wide prescription chart. The All Wales drug chart was mentioned, as leading the way in this respect. We have developed a postgraduate prescribing program used in our Junior Dr Child health induction for the last 10 years. We have also initiated further undergraduate training in medication safety in their child health block this year.

  We wish to report a successful audit cycle improving safe prescribing practice against these All Wales Guidelines.

  A selection of Paediatric inpatient medication charts were reviewed against the standards in November 2009 (N=44.). Following this targeted interventions were carried out including an additional two teaching sessions, emailing the audit and standards required to all SHOs and Registrars and placing a summary poster in the doctor's handover room. Re- audit was performed 4 months later involving (N=40) Paediatric inpatient charts.

  A selection of standards audited are summarised in table 1, including a statistical analysis with Fisher exact test.

  Prescribing errors continue to occur, however gentle progress can be made via a package of interventions. Although we cannot assess which of our interventions was effective we believe that electronically communicating audit results to junior doctors, who are often unable or unwilling to attend clinical governance sessions, may hold promise for improving prescribing practice.

  Lida Panagiotopoulou, Rowena McArtney, David Tuthill. Children's Hospital for Wales, Cardiff.

  Correspondence to Dr David Tuthill, Consultant Paediatrician, Children's Hospital for Wales, Heath Park, Cardiff, CF144XW. David.Tuthill@wales.nhs.uk

  Provenance and peer review Not commissioned; internally peer reviewed.

  REFERENCES:

  1. Maisoon Abdullah Ghaleb, Nick Barber, Bryony Dean Franklin, Ian Chi Kei Wong. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 2010;95:113 -118. doi:10.1136/adc.2009.158485

  2. Anon. New all-Wales drug chart looks set to increase patient safety. Hospital Pharmacist 2005;12:185

  3. Tim Dornan, Darren Ashcroft, Heather Heathfield, Penny Lewis, Jon Miles, David Taylor et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. 2009 Dec;2. Available from: http://www.gmc- uk.org/about/research/research_commissioned_4.asp

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 22 March 2016

  Prescription error: how to manage?

  • professor viroj wiwanitkit, physician

  Editor, I read the recent publication by Ghaleb et al with a great interest. Ghaleb et al concluded that prescribing and medication administration errors are not uncommon in paediatrics, partly as a result of the extra challenges in prescribing and administering medication to this patient group [1]. Indeed, the prescription error is a common problem in pediatrics. Luckily, in a recent systematic review, the rate of error w...

  Show More

  Editor, I read the recent publication by Ghaleb et al with a great interest. Ghaleb et al concluded that prescribing and medication administration errors are not uncommon in paediatrics, partly as a result of the extra challenges in prescribing and administering medication to this patient group [1]. Indeed, the prescription error is a common problem in pediatrics. Luckily, in a recent systematic review, the rate of error was more common in adults than children (about 4.5 times) [2]. "How to manage" is a big question. It is needed to set a system to check for the prescription error as well as promoting the awareness of practitioner before prescription. In addition, the reformatting of the present medical curriculum to improve the quality of prescription practice is also recommended [3]. Starting at medical students might result in an improvement in the future life as practitioner.

  References

  1. Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child. 2010 Feb;95(2):113-8.

  2. Lewis PJ, Dornan T, Taylor D, Tully MP, Wass V, Ashcroft DM. Prevalence, incidence and nature of prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32(5):379-89.

  3. Wangsaturaka D. Wiwanitkit V. An evaluation of prescription writing and rational prescribing in Third-Year Medical Students, Faculty of Medicine, Chulalongkorn University. Thai J Pharmacol 2000 May-Aug; 22(2): 115-20.

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top