RESEARCH POSTER PRESENTATION DESIGN 2012
www.PosterPresentations.com Dr Noa Keren, Dr Laura Haynes, Dr
Rosanna Bevan, Dr Reena Bhatt, Steve Tomlin, Dr Ronny Cheung and Dr
Alice Rouech Evelina Childrens Hospital, Guys 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 Patients 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 80-100% Legible writing Pharmacy
input Appropriate route of administration Appropriate
timings75-100% Results (contd) 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: 426-442. 2.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: 113118. 3.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
