Objectives To assess the quantity and variety of pharmacy interventions, to measure the quality of patient information on the prescription and to identify problem areas, all within specific paediatric clinics. If necessary, to implement changes to improve prescribing and reduce the need for pharmacist interventions, which in turn should reduce waiting times and improve patient experience.
Method No clinical standards or guidelines currently exist relating specifically to paediatric outpatient prescription requirements, however the Trust's policy for prescribing medicines should be adhered to where relevant. Data were prospectively collected using a piloted form, by the screening pharmacist, for all paediatric and A and E outpatient prescriptions during a 1-week period. The data were then broken down into the five main clinic groups and each standard looked at individually to identify areas for improvement.
Results 158 outpatient prescriptions were dispensed during the study period, with a total of 314 items. 53% (166/314) of items prescribed required a pharmacist intervention, however only 7% (23/314) required the prescriber to be contacted. The majority of the queries were resolved by communicating with the patient or carer. 40% (63/158) of prescriptions did not have a documented allergy status, 30% (15/50) no patient weight where appropriate and 5% (8/158) no date of birth.
Prescriptions from A and E were most likely to require pharmacy interventions; 82% (38/48) required a pharmacist intervention, 77% (27/35) had no allergy documented and 64% (7/11) had no weight documented when this was necessary for dosing.
There were a number of limitations to this audit. Limitations include data collection over a restricted time period, and potential bias from different pharmacists carrying out the data collection.
Conclusion Paediatric outpatient and A and E prescriptions at St Mary's Hospital are not meeting the set standards. The focus for improvement needs to be in paediatric A and E, where prescriptions are often lacking in patient information and pharmacists most frequently have to make interventions. This is probably because that the paediatric A and E prescription is different from the other outpatient prescriptions and does not have an allocated space for the prescriber to document the weight and allergy status. As a result of this audit, the A and E outpatient prescriptions will be amended; results of the study will also be fed back to the paediatric doctors.
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