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70 Think liver: a quality improvement project on anticipatory medication prescribing for patients with advanced liver disease
  1. Rozalind Whitaker,
  2. Sarah Collis and
  3. Jayne Kennedy
  1. Royal Albert Edward Infirmary


Introduction Advanced Liver Disease (ALD) is the second leading cause of premature death in 35–49-year-olds. Symptom burdens are high, and place of death is often hospital. Specialist advice in the form of guidelines is invaluable for junior doctors to provide timely, effective symptom management. At Royal Albert Edward Infirmary an ALD symptom management guideline was published in March 2022. A QIP was undertaken to increase junior doctor guideline awareness and confidence, and improve prescribing practice.

Methods Junior doctors were surveyed for awareness of guidelines and confidence in prescribing, with scores of 1–5. Concordance for anticipatory medication prescriptions was audited, including medication choice and dose (July 2021-November 2022). Interventions undertaken included: peer-teaching for rotating junior doctors, prescribing-aid posters, and reminder emails (June-October 2022). Awareness, and confidence levels were re-surveyed post-intervention and compared by T-test. Concordance was re-audited and trend and special cause variance assessed by run charts.

Results On a score of 1–5, awareness of guidelines increased from an average score of 1.29, to 4.78 (p<0.001) post-intervention. Prescribing confidence increased from an average score of 2.75 to 4.67 (p<0.001). Concordance with guidelines for all anticipatory medication choices significantly increased from 84.7% pre-intervention to 96.2% post-intervention (p=0.019). Run-chart data showed a significant positive shift in percentage of medication choices concordant with guidelines from July to October 2022. Concordance for opiate choices increased from 55.6% to 83.3%(p=0.050) but run-chart data showed no special cause variation. For anticipatory medication dosing, there was no significant change in prescribing performance, with concordance rising from 60.3% pre-intervention to 64.1% post-intervention (p=0.295) and run-chart data showed no special cause variation.

Conclusions Interventions resulted in greater junior doctor awareness, confidence, and improvement in anticipatory medication choices. Further work is required to highlight lower doses of anticipatory medications advised in ALD and to maintain awareness given junior doctor rotations.

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