1. Dolores Keating MPSI Head of Pharmacy
PHOTOGRAPH HERE
Dolores Keating MPSI
Head of Pharmacy
From Pen to Patient: Improving Prescription Writing Practice at a Psychiatric Teaching Hospital

2. Why Prescription Writing?
Medication errors are one of the most common causes of patient harm1 Poor prescription writing is a factor National and international patient safety issue Baseline audits in Irish hospitals show low rates of adherence to good practice guidelines2-5 Quality improvement processes including audit and feedback, educational initiatives, improving medication charts and multidisciplinary working can raise standards3-7 Sustaining improvements is a challenge
NPS, UK,
Farooq et al, It J Med Sci, 2008; 177;
Ahmed a et al, Ir J Psych Med 2011; 28(2): 84-86
Tully et al, Ir J Psych Med 2010; 27(2): 82-85
Bates et al, Ir J Med Sci: 2010; 179:
Dornan et al, EQUIP Study, 2009;
Health Foundation, UK, 2012;

3. Audit Criteria Allergy documentation Generic prescribing
Handwriting: written in block capitals or un-joined lower case
Start date
Discontinuation process completed
Patient name and MHIS number on each page (2012)
Prescribers signature bank and MCRN completed (2012)
PRN Medications
Dose specified
Interval specified with maximum frequency in 24 hours
Weekly review of PRN medications documented (2012)

4. Sampling STANDARD Every 4th name on an alphabetical list
25% of inpatient cohort over one week
N=40 to 50
Some standards may not apply to all charts e.g. if no PRN medication prescribed
STANDARD
100% adherence within the entire chart with the criteria
Exceptions defined
Brand name of a product that is not inter-changeable e.g. Priadel ®
‘nocte’ for frequency of hypnotic in PRN section

5. Interventions Pharmacists screening medication charts
Reinforcement of Standards
Medication safety event reports analysed
Dissemination of Guidelines
Active and Passive Feedback
Pre-audit
Introduction of a new medication charts
Dissemination of Good Prescribing Practice Guidelines
Baseline
2010
Intensive targeted feedback
Re-audit
Good Prescribing Practice Education
Review of Medication Chart
2012
Good Prescribing Practice Education Mandatory
Re-audit 2013
Pilot targeted feedback for PRN review
Improved medicines reconciliation
Re-audit 2014
Targeted feedback for Prescribers Signature and PRN standards
Format of Good Prescribing Practice Education Reviewed
Liam neeson
Periodic s

6. Targeted Feedback

7. Targeted Feedback

8. Education Small group teaching
Give relevant examples of why it is important to prescribe generically

9. Review of medication Chart
Draft HSE/State Claims Agency/Mental Health Commission Guidance for design & Governance of the Mental Health in- patient Medication Prescription & Administration Record (MPAR) 2012 National HSE MPAR Guidelines for Acute Hospitals 2012 Standards for the design of Hospital in-patient prescription charts UK: Academy of Medical Royal Colleges, Royal College of Nursing, Royal Pharmaceutical Society UK National In-patient Medication Chart Standards, Australia

10. Prompt to clarify time of administration

11. Prompt for rewriting chart during normal working hours

12. Layout of PRN section

13. Layout of PRN section

14. Supplementary charts

15. Medicines Reconciliation
Allergy documentation

16. Results

17. Results

18. Results

19. Challenges
Labour intensive Turnover of medical staff Sustainability Audit standard Passive dissemination of guidelines and feedback Different prescription charts and guidelines across the mental health services
Education alone didn’t have the desired effect
Particularly difficult to get compliance with local standards
Easiest thing to do

20. What worked?
Improve prescription charts Prescription monitoring by pharmacists Medicines reconciliation Audit and active feedback Education Multidisciplinary working Leadership Support at governance level Patient safety culture
Dynamic continuous quality improvement process
The leader can change but someone needs to pass on the baton

21. Where to now?
Medicines Management in Mental Health Education National Guidelines Electronic Prescription Writing
System
Continue to integrate pharmacists into mdts finalised. Excellent bespoke epr and electronic rx writing is on that IT development plan. Electronic systems when well designed and well maintained and we are in a good position to inform that development process.

22. Thank you Cathy Shelley Stephen Boss Brid O’Meara Ruairi Corkery
Aoife Davis
Audrey Purcell
Lorna Dillon
Caroline Hynes
Aoife Carolan
Ciara Dowling
De Abbie Lane
Dr Susan fletcher Jones
Dr Rory Shelley
Dr Stephen McWilliams
Dr Brendan Cassidy