1561 Strategies to Improve Paediatric Inpatient Prescribing Practice in the UK

Background and Aims Errors are common in paediatric inpatient prescribing. This audit cycle assessed the impact of new strategies aimed at reducing prescribing errors. Methods Drug charts from short-stay admissions in January 2010 were assessed retrospectively. Two gold standards were used; local hospital prescribing guidelines and the British National Formulary for Children (BNFC) 2009. From these results, a number of strategies were implemented to improve practice: prescribing training for new doctors was enhanced; a mandatory prescribing competency assessment was introduced; awareness was raised through local and regional presentations; increasing the availability of BNFC in clinical areas; daily pharmacy endorsements of drug charts and provision of Doctors’ name stamps; and recommendations for a drug chart re-design. We then re-audited using identical methods in July 2010. Results A total of 106 charts were assessed. Changes in documentation were found as follows: Improvements: reason for non-administration (+26%), allergy status (+20%), at least one medication pharmacy-endorsed (+16%), date of birth (+5%), dose in mg/kg where applicable (+5%), frequency for all medications (+2%), ‘micrograms’ written in full (+1%). No change: patient name (100%), no unofficial abbreviations (100%), weight (96%), signature when administered (96%). Worsening: appropriate decimals (–6%), doctor’s name stamp (–6%), start date (–5%), total dose (–2%), administration route (–1%). Conclusions This audit revealed significant improvements in paediatric prescribing following implementation of our recommendations. However, key areas were identified for further improvement. Current work includes continued development of training, a dedicated prescribing area on the ward, regular monitoring of drug charts and continuing re-audit.