P46 Review of medications/supportive care items prescribed at discharge for paediatric frame patients
Authors: Sinclair Fiona , Stillwagon Olivia 
Published: April 2023

Aim

Paediatric orthopaedic frame patients require a specific list of medications and supportive care items at the point of discharge, to adequately manage pain and to ensure that pin sites are well managed.1 2Currently there is no SOP/guideline that states what is needed on discharge, instead relying on doctors, nurses and pharmacists to remember what is needed, meaning there is a risk of omitting essential items. Therefore, this audit was undertaken to review if patients were prescribed essential items and the results used to implement a new guideline/SOP to aid prescribing.

Method

As there is no existing guideline/SOP for items required at discharge, standards were defined using a poster previously created to remind doctors, nurses and pharmacists of what to prescribe and supply on discharge. Data was collected from all paediatric frame patients (n=25) admitted to hospital from January 2019 to July 2021. Data was obtained from CareFlow EPR (electronic prescribing software) and JAC (medicine management software) to determine items prescribed and quantities supplied at discharge. Data was collected and analysed using Microsoft Excel.

Results

21/25(84%) of patients were prescribed paracetamol, 23/25(92%) were prescribed tramadol, 20/25(80%) were prescribed diazepam, 23/25(92%) were prescribed an antibiotic and 23/25(92%) were prescribed an appropriate antibiotic at discharge. Of patients prescribed tramadol at discharge, only 4/25(16%) were given a 14 day supply (correct quantity to supply), 15/25(60%) were given a 7 day supply, 1/25(4%) was given a 4 week supply, 1/25(4%) was given a 10 day supply, and 1/25(4%) was given a 5 day supply. 2/25(8%) were not prescribed tramadol. 14/25 (54%) had a request for their GP to continue the supply if needed. Of the patients prescribed diazepam at discharge, 18/25(72%) were prescribed diazepam short-term and only 2/25(8%) had a diazepam wean plan. 5/25(20%) were not prescribed diazepam. 21/25(84%) were prescribed sodium chloride 0.9% sachets, 21/25(84%) were prescribed Allevyn dressings, 22/25(88%) were prescribed chlorhexidine and 21/25(84%) were prescribed alcohol hand gel. Only 1/25(4%) patient was prescribed an NSAID on discharge (usually avoided in frame patients) and no rationale was documented.

Conclusion

Although many patients were prescribed appropriate medications and supportive care items at discharge, the audit demonstrated essential items are omitted and that there is great variation in supply of these items. Patients received from as little as a 5-day supply of tramadol to 4 weeks’ worth, and just under half of all patients did not have a request for their GP to continue supplying tramadol if needed. If a patient is not seen by their GP within 2 weeks of being discharged, this may lead to patients not being prescribed adequate analgesia. In addition, although many patients were prescribed diazepam at discharge, almost all patients had no clear plan of how to wean diazepam. An SOP/guideline would help standardise frame patients’ discharges, ensuring essential medications and supportive care items are not omitted, and ensuring appropriate supplies of these are given on discharge.

References

Ferreira N, Marais LC. Prevention and management of external fixator pin track sepsis.Strategies in Trauma and Limb Reconstruction2012;7:67–72.

Timms A, Vincent M, Santy-Tomlinson J,et al. Guidance on pin site care; report and recommendations from the 2010 consensus project on pin site care [Online]. London: Royal College of Nursing; 2011. Available from: http://file:///C:/Users/Sinclaifio/Downloads/PUB-004137.pdf [Accessed 5 July 2022]