Quality of prescribing for schizophrenia: Evidence from a national audit in England and Wales

Objective: The drug policy of Mali is based on the concept of essential generic drugs. The adoption of generic drugs in a program is often accompanied by irrational use of these drugs precisely because of the availability of these drugs. Thus, this study was initiated to assess the quality of prescribing and dispensing drugs in Mali. Methods: This is a descriptive cross-sectional study was conducted from 2004 to 2013, the survey was conducted in 20 primary health centers and 20 private pharmacies in three regions of the country. In each of these structures, 30 prescriptions filled at the time of the survey were collected. Results: The average number of drugs per prescription was 3.0 ± 1.3 and 2.4 ± 1.2, respectively, in the public and private sectors. Prescription of drugs under international name was 91.6% in the public sector and 37.2% in the private sector. The public sector prescribed 33.7% of injectable drug against 16.2% in the private sector (p <0.001). The average cost of a prescription was lower in the public sector (3415.3 FCFA or 5.21euros) than in the private sector (7111 FCFA or 10.85 euros).Conclusion: Generic drugs are commonly used in the public, but much less in the private sector. The treatment guidelines are already available, should be introduced interactively to medical practitioners, through visits and intensive supervision by more experienced managers in the hierarchy, it would be likely to improve the quality of prescribing practitioners.

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The National Pain Audit for specialist pain services in England and Wales 2010–2014

British Journal of Pain ◽

10.1177/2049463718814277 ◽

2018 ◽

Vol 13 (3) ◽

pp. 185-193 ◽

Cited By ~ 1

Author(s):

Cathy Price ◽

Amanda C de C Williams ◽

Blair H Smith ◽

Alex Bottle

Keyword(s):

Quality Improvement ◽

Waiting Times ◽

Pain Clinic ◽

Standards Of Care ◽

National Audit ◽

England And Wales ◽

Safety Standards ◽

Diagnostic Coding ◽

Pain Clinics ◽

Pain Services

Introduction: Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A National Audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This article describes a Quality Improvement Programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods: Clinics were audited over a 4-year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results: 94% of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35–56%, p < 0.001) over the 4-year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. Conclusion: A National Audit found that while generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.

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P14 Reducing medication errors using prescribing nudges: intravenous aciclovir on paediatric intensive care

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-nppg.23 ◽

2020 ◽

Vol 105 (9) ◽

pp. e13.1-e13

Author(s):

Jenny Gray ◽

Nicholas Jones ◽

Olivia Fuller ◽

Andrew Schia

Keyword(s):

Intensive Care ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Error Rate ◽

Paediatric Intensive Care ◽

Electronic Prescribing ◽

Second Phase ◽

Quality Of Prescribing

AimThis Quality Improvement project is the second phase of a long term project to improve the quality of prescribing on the paediatric intensive care unit (PICU). Small adjustments are made to the electronic prescribing (EP) system, known as ‘nudges’, with the aim of improving the quality of prescribing in terms of error rate or user experience.1 2Intravenous aciclovir is prescribed to most patients admitted to the PICU with suspected meningitis/encephalitis. There is a complicated dosing schedule where the prescriber must decide whether to use body surface area (BSA) or weight to calculate the required dose. Underdosing risks subtherapeutic treatment of a viral encephalitis and overdosing risks acute kidney injury. Within our EP system, dosing by weight can be automated, but dosing by BSA cannot.A project in 2018 used a ‘nudge’ to alter the order of prescribing options in the drop down menu on the EP system. This reduced the error rate from 26% to 17% by reducing the likelihood of picking the wrong indication for acyclovir.3 However, a re-audit in October to December 2018 found the error rate had crept back up to 32%. Prescribing on the EP system is a multi-step process. Prescribers had to pick ‘aciclovir’ to choose the weight based dose or ‘aciclovir injection 3 month-11 yr‘ to choose the BSA based dosing. When ‘aciclovir’ was picked, this removed the body surface area dosing option from the prescriber’s screen and led them in the direction of an incorrect dose.MethodThe intervention for this project was to amalgamate all weight and BSA dosing options for acyclovir within the EP system, and then order them by age so that the prescriber could see all options simultaneously. This change was designed and implemented by our electronic prescribing support pharmacist in April 2019. Pre and post change prescriptions were audited by pharmacy undergraduate students for accuracy using data downloaded from the EP system.ResultsThe error rate post change was 8% (pre change 32%). The remaining errors reflect transcribing of an incorrect dose initiated outside of the PICU from a referring ward or hospital.ConclusionThis project shows that small, ‘smart’ changes within EP configuration can improve the quality of prescribing.Future work involves working with the software company to incorporate the ability to automatically calculate the dose based on BSA, further reducing the need for manual calculations. This project would not have been possible without the skills and knowledge of our electronic prescribing support pharmacy team.ReferencesPatel MS, et al. Nudge units to improve the delivery of health care. NEJM 2018; 378: 214–216Cafazzo JA, et al. From discovery to design: the evolution of human factors in healthcare. healthcare quarterly 2012; 15: 24–29Gunning C, Gray J. Audit of acyclovir prescribing to assess whether changing the order of drop down box options in an electronic prescribing system can reduce prescribing errors. Archives of Disease in Childhood 2019; 104:7

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