RESEARCH POSTER PRESENTATION DESIGN © Dr Noa Keren, Dr Laura Haynes, Dr Rosanna Bevan, Dr Reena Bhatt, Steve Tomlin, Dr Ronny Cheung and Dr Alice Roueché Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation trust Summary Aims The problem Improvements Learning and next steps We looked at prescribing standards on Mountain ward, a general paediatric ward which has 44 beds covering general paediatrics, general surgery, ENT and High Dependency Unit. We used a PDSA approach to improve prescribing. Improvement is ongoing. Achieve 100% compliance with prescribing standards within six months Analyse incident forms regarding prescribing on Mountain ward in 2014 Assess 5 paper drug charts per week, selected at random for each bay of the ward assessment categories based on national prescribing standards, trust guidelines and errors noted in incident forms from 2014 Items assessed: Patient details Allergy box completed + signed Patient’s weight All medications signed + dated Appropriate dose + units for weight + route Stop date signed + dated Fluids clearly prescribed Legible writing Appropriate timings Pharmacy input Antibiotics review date charted Appropriate route of administration No duplicate prescriptions No issues overall PDSA cycle approach to change Initiate training/teaching/prompts according to errors noted Continue to reassess drug charts weekly to assess impact of ‘intervention’ Results Prescribing standards are generally very high Focus education on aspects done less well –documentation of when medications are stopped, fluid prescriptions and legible writing Further input from pharmacy and sharing learning objectives with other teams within the hospital and the wider paediatric community. Continue to re-assess prescribing standards regularly to assess long term effects of education and identify new areas of focus by regular review of incident forms in the department. Incorporating prescribing teaching and RCPCH prescribing assessment into induction. This involved undertaking the assessment and getting individual feedback in person. This took place twice; at the beginning of March and April as charted in figure II. The first session had 11 doctors from Mountain ward and the second had 6. Improvements planned: Targeted education sessions addressing prescribing problem areas Prompt cards Posters on the ward – targeting a different standard each month according to most recent results Method 5 charts each week were assessed over 8 weeks List of good things: Item assessedPercentage achieved Patients’ details100% Patients’ weight No duplicates prescriptions Appropriate dose and units for weight + route % Legible writing Pharmacy input Appropriate route of administration Appropriate timings75-100% Results (cont’d) Standards to be improved: Overall compliance with prescribing standards: Figure 1: Prescribing standards with lowest compliance (percentages) Figure II: Overall compliance with all prescribing standards each week (percentages) References Prescribing teaching at induction Introduction of prompt cards Prescribing teaching at induction Medication errors are a common occurrence in the healthcare setting and are the most common type of errors in paediatric medicine 1 We know that up to 13% of inpatient paediatric prescription charts in the UK contain a medication error 2 A 2009 NPSA review showed that medication incidents constituted 17% of patient safety incidents for children and 15% for neonates. 3 Local Problems: Medicines safety is important – reference. Multiple patient safety issues around prescribing were highlighted by 16 prescribing related incident reports in 2014 for Mountain ward 15 reported as no harm, 1 low harm 50% to do with medication dosing 1.Levine S, Cohen M, Blanchard N, Frederico F, Magelli M, Lomax C, Greiner G, Poole R, Lee C, Lesko A (2001) Guidelines for preventing medication errors in pediatrics. The Journal of Pediatric Pharmacology and Therapeutics 6: Ghaleb M, Barber N, Franklin BD, Wong I. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Archives of Disease in Childhood 2010; 95: 113– National Patient Safety Agency 2009 Review of patient safety for children and young people. London. National reporting and Learning Service. Prompt Cards for prescribing fluids in children