Preventing Alteration of Paediatric Prescriptions A Quality Improvement Project Dr David Grier, Consultant Paediatrician Craigavon Area Hospital, Southern Health and Social Care Trust BACKGROUND 1 in 5 reported incident on the Paediatric ward in CAH is a medication incident Half of medication incidents result from prescription errors Alteration of prescriptions can result in illegibility of prescription and confusion of drug, dose or frequency Alteration of prescriptions is common (admitted by a number of doctors on questioning) Alterations are rarely reported on Datix (Incident reporting system) Aim: To Stop Alteration and Improve Legibility of Prescriptions in Paediatrics in Craigavon Area Hospital by June 2014 Measure: sample 5 Kardexes weekly. Count number of altered and illegible prescription Changes: Engage with prescribers meetings to educate them about the effects of their prescribing behaviours. Enforce policies on prescribing. DRIVER DIAGRAM FOR REDUCTION OF PRESCRIBING ERRORS NEWSLETTERS CONCLUSIONS There has been a sustained reduction in the number of altered and illegible prescriptions after prescribers were educated and nurses empowered not to administer altered or illegible prescriptions. This very small, simple Quality Improvement Project has demonstrated that simple messages and constraining factors can lead to safer prescribing behaviours. Secondary Drivers Primary Drivers Addressed by this QI Project RUN CHARTS (5 Kardexes Reviewed/Week) To reduce prescribing errors in Paediatric Ward in Craigavon Hospital Improve Legibility No Alterations Improved Handwriting/ printed prescriptions Correct Drug for Patient and Condition Obtaining accurate Medical & Drug History Adherence to Drug policies Correct Dose Use of BNFc Quiet Area to Prescribe Independent Checking of Dose Primary Outcome AIMS AND CHANGES BASED ON PRIMARY DRIVERS Aim 1: Reduce Prescription of Alterations 1.Provide prescribers with two simple messages: “Stop altering prescriptions” “Nurses will contact prescribers to rewrite prescriptions if altered” 2.Newsletter to reinforce message and provide positive feedback. Aim 2: To Improve Legibility of Prescriptions 1.Provide prescribers with three further messages: “Read your prescription after writing it.” “Could drug name, dose or time be confused with anything else?” “Nurses will contact prescribers to rewrite prescriptions if illegible” 2.Newsletter to give examples of altered and illegible prescriptions. NURSES AS CONSTRAINTS “A constraint restricts the performance of certain actions.” Langley et al (2009) The Improvement Guide (2 nd Edition) Paediatric Nurses will not administer prescriptions which have been altered or are illegible. They will contact prescribers to rewrite the prescription. Prescribers therefore know that they will not safe time by altering prescriptions and it is easier for them to rewrite rather alter prescriptions. THANKS Paediatric Nursing and Medical Staff, CAH Mr Richard Clements, Pharmacist, CAH The Cross Border Patient Safety Programme, PHA and CAWT