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An audit of paediatric ambulatory prescriptions
  1. M Baynes,
  2. K Hall
  1. Hammersmith Hospital, Imperial College Healthcare NHS Trust, London


Background Imperial College Healthcare NHS Trust is made up of five hospitals over three different sites. The only paediatric service at the Hammersmith Hospital site is a paediatric ambulatory unit (PAU); all other services are at St. Mary's Hospital. Hammersmith Hospital pharmacy recently raised concerns regarding outpatient prescriptions from PAU:

  • ▸ Prescription numbers had increased and a decrease in FP10HNC (Prescription pad used by hospital outpatient services) reimbursement was reported, coinciding with increased waiting times at pharmacy outpatients. Following this a guideline for FP10HNC prescribing was launched (including an approved generic medicines list).

  • ▸ The issuing of stock discharge pre-packs to PAU had decreased.

  • ▸ Dispensary pharmacists reported that they were often contacting the prescriber (eg, dose rounding) due to the pharmacist's lack of confidence.

Background The aim of this audit was to identify PAU prescriptions coming to Hammersmith Hospital pharmacy to assess if changes could be made to improve the current system. The standards were:

  • 1. 100% of prescriptions should be dispensed within an hour of arrival;

  • 2 None of these medicines should be available as pre-packs;

  • 3 The prescriber should be contacted for no more than 10% of prescriptions;

  • 4 No more than 25% of these medicines should be available on the approved FP10HNC list.

Methods A data collection form was used to prospectively obtain data over 2 weeks. Each form was second checked by a specialist pharmacist to ensure robust results.

Results 140 prescriptions were received and 197 medications prescribed. 26/140 prescriptions were not timed stamped.

  • 1. 89% of prescriptions (102/114) were dispensed within an hour. The average turnaround time was 37 min. 12 prescriptions took over an hour of which 42% arrived during lunchtime and 50% were available as pre-packs.

  • 2. 31% of prescriptions (43/140) could have been completely dispensed on the ward using pre-packs. This would have reduced patient waiting times by a cumulative total of over 24 h, or approximately 33 min per patient.

  • 3. 12% of prescriptions (17/140) included evidence of a prescriber being contacted.

  • 4. 76% of medicines (150/197) were on the approved FP10HNC list.

Results 46% of medicines were anti-infectives; amoxicillin was commonly prescribed which is not in line with antibiotic usage at St. Mary's Hospital.

Conclusions These results highlight that the use of pre-packs and FP10HNC prescriptions is not being optimised which may affect patient experience. The limitations of this audit are that not all prescriptions were timed in and out and that 1 week of the audit coincided with school holidays. The recommendations are:

  • ▸ Adherence to antibiotic policies should be assessed.

  • ▸ The appropriate use of FP10HNC prescriptions should be encouraged during training and education sessions.

  • ▸ Prescriptions for non-urgent medicines should be referred to the patient's General Practitioner (GP) where appropriate.

  • ▸ The advantages of pre-packs should be re-highlighted through nursing training sessions.

  • ▸ The pre-packs available, and their labels, should be reviewed to ensure they are fit for purpose.

  • ▸ These results should be presented to PAU to form part of ongoing projects aiming to determine why parents come to PAU rather than their GP.

  • ▸ Re-audit when changes have been made.

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