1. DART - on target for safe prescribing Karin Purshouse Judith Bailey Jane Hough Triss Clark

2. Today  Prescribing errors  What is DART?  Group work

3. Prescribing errors  Nationally  1 in 10 patients = adverse event  15% of these are medication related

4. Case  75 year old lady with advanced cancer, brain and bone metastasis  Admitted with general malaise, vague neurological symptoms  Attended with sister and bag of medications  Stated she had forgotten her morphine, but normally took 100mg MST.

5. Case continued  SHO prescribed 100mg MST and asked sister to check medication at home.  Next day…  Medicine reconciliation by pharmacist, found patient actually took 20mg MST BD.  Sister had called the ward and message hadn’t been handed on.  Patient was completely well, slightly drowsy.

6. Case learning points  Near miss  Prompted this Quality Improvement Project on prescribing.  Prescribing errors can happen to everyone  Any examples?

7. Evaluation of prescribing in EAU and medical wards – Dec/Jan 2013/14  1 in 5 prescriptions had an error  Nearly HALF were due to drug omissions on admission  Nearly a THIRD were dose-related (mostly over-dosing)  10% were due to incorrect/absent drug timings  Of high-risk drugs, antibiotic and insulin prescribing was least accurate

8. You are agents for change!

11. D DOCUMENTATION - Complete the prescription CLEARLY in full so it can BE GIVEN SAFELY. Clearly document changes to medicines in the medical notes. A ALLERGIES - Is the patient allergic to the drug? Have I checked and documented this? R REGULAR MEDICATIONS - Do I know the patients' regular medications? - Find out via OxCS. Check the pharmacy box in the drug chart. T TIME CRITICAL MEDICINES- Does this medication need to be given STAT? Tell the nursing staff!

12. Oxfordshire Care Summary 1) Search ‘Oxfordshire Care Summary’ 2) Complete training 3)Use when clerking!

13. For those in AGM/Medicine: Prescribing simulation sessions  Multidisciplinary (Nurses, doctors, pharmacists)  Dates:  Friday 11 th April 2-3pm, 3.30-4.30pm AGM seminar room  Wednesday 16 th April 2-3pm, 3.30-4.30pm GPEC seminar room 2B  One hour, coffee+cake and certificate for your e- portfolio  Consultants will be looking for your participation.

14. Groups  Cases from actual scenarios found in the study  Discuss the cases and amend the prescriptions  Take a DART card for your badge holders