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Standards of prescription writing in a long-term psychogeriatric unit: a series of clinical audits

Published online by Cambridge University Press:  13 October 2014

L. S. Wilson ,
P. Devitt  and
O. Hally
L. S. Wilson*
Affiliation:
Department of Psychiatry of Old Age, St. Ita’s Hospital, Portrane, Donabate, Co. Dublin, Ireland
P. Devitt
Affiliation:
Department of Psychiatry of Old Age, St. Ita’s Hospital, Portrane, Donabate, Co. Dublin, Ireland
O. Hally
Affiliation:
Department of Psychiatry of Old Age, St. Ita’s Hospital, Portrane, Donabate, Co. Dublin, Ireland
*
*Address for correspondence: L. Wilson, Department of Psychiatry of Old Age, St. Ita)s Hospital, Portrane, Donabate, Co. Dublin, Ireland. (Email: [email protected])
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Abstract

Objective

The aim of this study was to improve the quality of prescription writing in a long-term psychogeriatric inpatient unit by a combination of serial audits and interventions designed to address the identified deficiencies.

Methods

We undertook three clinical audits of the prescription sheets used in an inpatient unit providing continuing care for residents with severe and enduring mental illness and dementia. Based on the findings of the first audit a set of prescribing guidelines was implemented into the ward. Following the second audit a new prescription sheet was developed. The format of the new prescription sheet was designed to account for the needs of the unit and to adhere to Irish and UK best practise guidelines. Two months after its introduction we undertook a third audit.

Results

Completion of the drug sensitivity box increased from 25% at audit one to 100% at audit three. Other specific aspects of prescription writing that had been poor at the beginning of the audit cycle also showed improvement: prescribing of generic psychotropic drugs increased by 69% and inclusion of the prescribers Medical Council Registration Number increased by 78%. However, some basic aspects of prescription writing remained weak such as frequency of drug administration and documentation of the stop/review date for ‘as required’ medication.

Conclusion

The results of this study suggest that clinical audit and feedback can improve the quality of prescriptions in an in-patient setting.

Keywords

Ageddrug monitoringdrug prescriptionmedical auditmedication errorsmental disorderspsychiatry
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 32 , Issue 2 , June 2015 , pp. 197 - 204
Copyright
© College of Psychiatrists of Ireland 2014 

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References

Bates, DW, Boyle, D, Vander Vliet, MB, Schneider, J, Leape, L (1995a). Relationship between medication errors and adverse drug events. Journal of General Internal Medicine 10, 199–205.Google Scholar
Bates, DW, Cullen, DJ, Laird, N, Petersen, LA, Small, SD, Servi, D, Laffel, G, Sweitzer, BJ, Shea, BF, Hallisey, R (1995b). Incidence of adverse drug events and potential adverse drug events: implications for prevention. The Journal of the American Medical Association 274, 29–34.CrossRefGoogle ScholarPubMed
Coombes, ID, Stowasser, DA, Reid, C, Mitchell, CA (2009). Impact of a standard medication chart on prescribing errors: a before-and-after audit. Quality and Safety in Health Care 18, 478–485.CrossRefGoogle ScholarPubMed
Data Protection Commissioner (2007). Data Protection Guidelines on Research in the Health Sector. Data Protection Commissioner: Dublin.Google Scholar
Finley, PR, Crismon, ML, Rush, AJ (2003). Evaluating the impact of pharmacists in mental health: a systematic review. Pharmacotherapy 23, 1634–1644.Google Scholar
General Medical Council (2009). An in Depth Investigation into Causes of Prescribing Errors by Foundation Trainees in Relation to their Medical Education – EQUIP Study. General Medical Council. (http://www.gmc-uk.org/about/research/25056.asp). Accessed 3 May 2014.Google Scholar
Gommans, J, McIntosh, P, Bee, S, Allan, W (2008). Improving the quality of written prescriptions in a general hospital: the influence of 10 years of serial audits and targeted interventions. Internal Medicine Journal 38, 243–248.Google Scholar
Hallahan, B, Murray, I, McDonald, C (2007). Improving prescription quality in an in-patient mental health unit. Psychiatric Bulletin 31, 435.Google Scholar
Health Information and Quality Authority (HIQA) (2008). National Quality Standards for Residential Care Settings for Older People in Ireland (http://www.hiqa.ie/system/files/HIQA_Residential_Care_Standards_2008.pdf). Accessed 3 May 2014.Google Scholar
Holland, R, Desborough, J, Goodyer, L, Hall, S, Wright, D, Loke, YK (2008). Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. British Journal of Clinical Pharmacology 65, 303–316.CrossRefGoogle ScholarPubMed
Joint Formulary Committee (2010). British National Formulary, 59th edn. British Medical Association and Royal Pharmaceutical Society of Great Britain: London.Google Scholar
Kripalani, M, Badanapuram, R, Bell, A (2007). Audit on inpatient prescription writing guidelines. Journal of Psychiatric and Mental Health Nursing 14, 598–600.CrossRefGoogle ScholarPubMed
Leape, LL, Brennan, TA, Laird, N, Lawthers, AG, Localio, AR, Barnes, BA, Herbert, L, Newhouse, JP, Weiler, PC, Hiatt, H (1991). The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. The New England Journal of Medicine 324, 377–384.CrossRefGoogle ScholarPubMed
Leape, LL, Cullen, DJ, Clapp, MD, Burdick, E, Demonaco, HJ, Erickson, JI, Bates, DW (1999). Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. Journal of the American Medical Association 282, 267–270.Google Scholar
Maidment, ID, Haw, C, Stubbs, J, Fox, C, Katona, C, Franklin, BD (2008). Medication errors in older people with mental health problems: a review. International Journal of Geriatric Psychiatry 23, 564–573.Google Scholar
Maxwell, SRJ, Wilkinson, K (2007). Writing safe and effective prescriptions in a hospital kardex. Journal of the Royal College of Physicians of Edinburgh 37, 348–351.Google Scholar
Medical Council (2009). Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 7th edn. Medical Council, Dublin (http://www.medicalcouncil.ie/News-and-Publications/Publications/Information-for-Doctors/Guide-to-Professional-Conduct-and-Ethics-for-Registered-Medical-Practitioners.pdf). Accessed 5 May 2014.Google Scholar
Mental Health Act (2001). Dublin: Irish Statute Books. Part 4, Sections 57–60. (http://www.irishstatutebook.ie/pdf/2001/en.act.2001.0025.pdf). Accessed 3 May 2014.Google Scholar
Nirodi, P, Mitchell, AJ (2002). The quality of drug prescribing in patients in psychiatric units for the elderly. Aging and Mental Health 6, 191–196.Google Scholar
Office of the Attorney General (2007). Irish Statute Book. Medical Practitioners Act 2007. 25. Part 6 Registration of Medical Practitioners, Section 43, Subsection 8. (http://www.irishstatutebook.ie/pdf/2007/en.act.2007.0025.pdf). Accessed 5 May 2014.Google Scholar
Paton, J, Wallace, J (1997). Medication errors. The Lancet 349, 959–960.Google Scholar
Ryan, C, Ross, S, Davey, P, Duncan, EM, Francis, JJ, Fielding, S, Johnston, M, Ker, J, Lee, AJ, Macleod, MJ, Maxwell, S, McKay, GA, McLay, JS, Webb, DJ, Bond, C (2014). Prevalence and Causes of Prescribing Errors: The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study. PLoS One 9, e79802, (http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0079802&representation=PDF). Accessed 6 May 2014.Google Scholar
Stubbs, J, Haw, C, Taylor, D (2006). Prescription errors in psychiatry – a multi-centre study. Journal of Psychopharmacology 20, 553–561.Google Scholar
Thong, BYH, Tan, TC (2011). Epidemiology and risk factors for drug allergy. British Journal of Clinical Pharmacology 71, 684–700.Google Scholar
Ved, P, Coupe, T (2007). Improving prescription quality in an in-patient mental health unit: three cycles of clinical audit. Psychiatric Bulletin 31, 293–294.Google Scholar
Velo, GP, Minuz, P (2009). Medication errors: prescribing faults and prescription errors. British Journal of Clinical Pharmacology 67, 624–628.Google Scholar
World Medical Association (2008). WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. World Medical Association: Ferney-Voltaire.Google Scholar