Background The safe and effective function of any in-patient unit depends on drug charts being clearly and correctly completed.
Aims To assess the adherence of the medical team to good prescribing practices regarding completion of drug charts. To explore whether audit of this area as part of the junior doctor induction programme provides a means to improve prescribing documentation habits.
Methods The audit tool analysed compliance with standards established by the Sue Ryder Management of Medicines Policy for Care Centres and Hospices (July 2014). Junior doctors analysed the notes and drug charts of 10 in-patients sampled at random. Performance of the entire medical team was audited at the beginning and end of 2 successive junior doctor placements.
Standards Audited fields were
Chart completion: eg, capitals; generic names.
Technical information: eg, correct use of units, decimals etc.
Prescriptions written correctly: eg, signed, dated, PRN indications etc.
The standard set for all criteria was 100%.
Results Each audit fell significantly short of the desired standard of 100% in the 26 possible criteria. Both audit cycles demonstrated improvement in prescribing performance. Between December 2014 and February 2015, 100% concordance rose from 32% (8/25) to 50% (11/22) of assessed criteria, with betterment seen in another 73% (8/11). Comparison of April 2015 and July 2015 saw 100% concordance increase from 28% (5/23) to 69% (18/26) with progression in a further 40% (2/5) of criteria.
Discussion and conclusion Reflecting on the data, it was clear that those who had been auditors became better prescribers. Most of the remaining errors were made by consultants and registrars! This project suggests that involving junior doctors in prescribing audits is effective at educating them in good prescribing practice. Perhaps senior doctors would also benefit from engaging in such an exercise?
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