Introduction As part of discussions at the Nurse Independent Prescriber Group, we agreed to focus on the team’s use of Drug Instruction Charts because:
They are widely used for end of life care prescribing.
They are used in an anticipatory way.
They are used by staff outside of our service to initiate treatment.
There were particular challenges during COVID-19 due to some prescribers working remotely; historically, our charts have been completed by hand.
Method We developed an audit tool with two parts:
Part 1 – Completion of form – all patient details complete; legibility; additional information documented (e.g. estimated glomerular filtration rate [eGFR], transdermal medication also in use).
Part 2 – Appropriateness of prescribing – drugs prescribed were appropriate in line with diagnosis, prognosis, risk, renal function.
The audit was carried out by the head of community services and an associate specialist/consultant in palliative medicine.
We also created a process to enable remote completion of the Drug Instruction Charts. This was far from simple, involving many staff with IT skills and access to additional software (and a determined Medical Director!). A Standard Operating Procedure for electronic completion of Drug Instruction Charts was developed to ensure robust governance.
Results Results were input into a spreadsheet developed by the hospice data analyst. Each prescriber submitted Drug Instruction Charts they had completed. Results were shared with each individual prescriber for their learning. Overall results were shared with all prescribers.
Conclusions Compliance with the form and appropriateness of prescribing were overwhelmingly positive but there are improvements that can be made to practice. The process of developing the electronic chart was in itself helpful as it opened up discussions about electronic completion of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form, as well as governance. The implementation of electronic completion of the charts means that prescribers working remotely or on call can now complete Drug Instruction Charts in a timely way, improving experience for patients, families and staff.
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