Improving Paediatric Prescribing on a General Paediatric Ward
Improving prescribing standards on a general paediatrics ward where multiple patient safety issues around prescribing were highlighted in a busy inner city children’s hospital using a PDSA approach.
Medication errors are a common occurrence in the healthcare setting and are the most common type of errors in paediatric medicine. We know that up to 13% of inpatient paediatric prescription charts in the UK contain a medication error. A 2009 NPSA review showed that medication incidents constituted 17% of patient safety incidents for children and 15% for neonates.
Local Problems: Multiple patient safety issues around prescribing were highlighted by 16 prescribing related incident reports in 2014 for Mountain ward (15 reported as no harm, 1 low harm, 50% to do with medication dosing)
To achieve 100% compliance with prescribing standards within six months.
Making the Case for Change
Prescribing safety is already a priority for the Trust and recent clinical governance meetings had also highlighted the need to improve standards. A similar project had been tried before but had lost momentum so a keen team were recruited to restart the project and make it sustainable.
The team included consultants, doctors in training, pharmacists and nurses. In order to engage ward prescribers (the majority of whom are junior doctors) initial efforts were targeted at induction.
Prescribing teaching and RCPCH prescribing assessment were incorporated into junior doctor induction. This took place twice; at the beginning of March and April. The first session had 11 doctors from Mountain ward and the second had 6.
Prompt cards providing information for prescribing fluids for children were given out in the April induction session.
Data has been collected through the selection of 5 random drug charts each week which are scored against our prescribing standards. The results so far are displayed on the poster available for download below.
A PDSA approach has been used whereby small changes are tried out and the effects monitored.
Learning and Next Steps
Prescribing standards are generally high but we still have adverse incidents and must look at root cause analysis to identify the system problems. We will now focus education on aspects done less well – documentation when medications are stopped, fluid prescriptions and legible writing.
Planned improvements include targeted education sessions; educational posters on the ward addressing a different standard each month.
We intend to get further input from pharmacy and share our learning with other teams within the hospital and wider paediatric community.
We will continue to assess prescribing standards regularly to evaluate the long term effects of changes and identify new areas.
The project has the approval of the department and the local pharmacy team.
Project leads: Dr Noa Keren, Dr Laura Haynes, Dr Rosanna Bevan, Dr Reena Bhatt. Supervised by Dr Alice Roueché (Paediatric Consultant)
Organisation: Evelina London Children’s Hospital, Guy’s and St Thomas’ Hospital NHS Foundation Trust