Background Whilst working on the adult inpatient wards at The Royal Marsden Hospital (RMH), it was noted that anti-emetics were frequently prescribed incorrectly particularly in combination (e.g. metoclopramide with domperidone, or metoclopramide with cyclizine). We felt a quality improvement project that included a simple intervention involving a teaching session to junior doctors on anti-emetic prescribing could improve knowledge and practice.
Methods Data was collected from inpatient medication charts, both before and after the intervention. We aimed to collect data from 25–50 charts with at least one anti-emetic prescription. All anti-emetic prescriptions were recorded along with any prescribing errors (including incorrect combination, incorrect dose/frequency/max dose/route).
A teaching session was delivered to all RMH SHOs highlighting anti-emetic interactions/cautions and safe prescribing practice. SHOs were also asked to complete a questionnaire before and after the teaching session to assess confidence in anti-emetic prescribing.
Results Drug charts were analysed from 37 patients between 13/03/18 and 10/04/18. 5 prescribing errors were found (13.5%). 37 new drug charts were analysed 1 week after the intervention. 0 prescribing errors were found (0%). SHO questionnaires were completed with an average confidence level of 3.1 (out of 5) before the intervention and 4.3 after.
Conclusions The results show a reduction in prescribing errors and an improvement in prescribing confidence post-intervention. This shows that simple teaching interventions can improve prescribing safety and confidence.
We plan to implement a similar teaching session at induction for each new cohort of junior doctors to ensure these changes are lasting. SHOs rotating to palliative care/oncology placements are often not familiar with prescribing anti-emetic combinations as they have usually come from other medical specialities where their use is less common. This small project has shown how targeted teaching interventions can improve anti-emetic prescribing practice and patient care, and could be easily replicated at other centres.
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