An audit of the accuracy of neonatal inpatient prescription charts

Field: Health Professions (Health Sciences)

<sec><st>Objective</st> Studies<cross-ref type="bib" refid="R1">1</cross-ref> <cross-ref type="bib" refid="R2">2</cross-ref> <cross-ref type="bib" refid="R3">3</cross-ref> have shown that the majority of medication errors occur during prescribing and administration which places emphasis on ensuring prescription charts are legible and unambiguous. Our objective was to determine the accuracy and clarity of prescribing on the new Imperial College Healthcare NHS Trust (ICHT) neonatal inpatient prescription chart, on the two neonatal units at ICHT, based on the following audit standards:<l type="ord"><li> 100% of charts should state the correct demographic data (surname, hospital number, date of birth, gestational age, birth weight); </li><li> 100% of charts should state the correct ward; </li><li> 100% of charts should be legible, use approved abbreviations, and be unambiguous; </li><li> 100% of prescriptions should be signed and dated by the prescriber; </li><li> 100% of discontinued medicines should be cancelled according to hospital policy. </li></l> </sec> <sec><st>Method</st> Data collection was completed by two pharmacists, one at St Mary's Hospital (SMH) and one at Queen Charlotte's and Chelsea Hospital (QCCH), over 4 weeks during December 2010 and January 2011. A piloted data collection form recording compliant, non-compliant or not applicable was used. Up to 10 charts that were previously unseen by a pharmacist were audited each week. If 10 charts were not eligible then unscreened newly prescribed items were audited against standards 3–5. Patients could be audited more than once. </sec> <sec><st>Results</st> 75 charts were audited (SMH n=35, QCCH n=40), 47 were for new patients, 11 were rewritten charts and 17 were just for new items. 58 charts were used to assess standards 1 and 2. On average, each patient was prescribed between two and three medications. SMH had lower adherence to standards 1 and 2 compared with QCCH but standards 3–5 scored comparably. No standard received 100% compliance across both sites, and only one component, whether the correct patient surname was recorded on the drug chart, fully complied. <l type="ord"><li> 100% (n=58) of charts stated the patient's surname, but the hospital number is the unique patient identifier and 12% (n=3) of charts at SMH and 3% (n=1) at QCCH did not have the hospital number stated. </li><li> The correct ward was not stated on 12% (n=7) of charts. </li><li> 4% (n=3) of charts had illegible content. 8% (n=6) contained ambiguous routes for administration. </li><li> One QCCH chart contained an item not signed by the prescriber. </li><li> 11% (n=8) of charts did not have a clear cancellation of all medicines (QCCH n=6, SMH n=2). </li></l> </sec> <sec><st>Conclusions</st> There are failings on both sites with adherence to prescribing standards. Particularly low compliance was recorded for the cancellation of discontinued medicines at QCCH and recording of hospital numbers at SMH. The limitations of this audit include the use of two data collectors, whose perceptions may differ for standards 3–5, different sample sizes between the two sites and the number of newly prescribed items assessed. Extra pharmacy training is recommended to provide more support for prescribers followed by regular audits with timely feedback. </sec>