scholarly journals Pharmacist-assisted electronic prescribing at the time of admission to an inpatient orthopaedic unit and its impact on medication errors: a pre- and postintervention study

2019 ◽  
Vol 10 ◽  
pp. 204209861986398 ◽  
Author(s):  
Tim Tran ◽  
Simone E. Taylor ◽  
Andrew Hardidge ◽  
Elise Mitri ◽  
Parnaz Aminian ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Medication Errors ◽  
Elective Surgery ◽  
Median Number ◽  
Electronic Prescribing ◽  
Vte Prophylaxis ◽  
Dose Time ◽  
Secondary Endpoints ◽  
Time Of Admission ◽  
Postoperative Dose

Background: Prescribing and administration errors related to pre-admission medications are common amongst orthopaedic inpatients. Postprescribing medication reconciliation by clinical pharmacists after hospital admission prevents some but not all errors from reaching the patient. Involving pharmacists at the prescribing stage may more effectively prevent errors. The aim of the study was to evaluate the effect of pharmacist-assisted electronic prescribing at the time of hospital admission on medication errors in orthopaedic inpatients. Methods: A pre- and postintervention study was conducted in the orthopaedic unit of a major metropolitan Australian hospital. During the 10-week intervention phase, a project pharmacist used electronic prescribing to assist with prescribing admission medications and postoperative venous thromboembolism (VTE) prophylaxis, in consultation with orthopaedic medical officers. The primary endpoint was the number of medication errors per patient within 72 h of admission. Secondary endpoints included the number and consequence of adverse events (AEs) associated with admission medication errors and the time delay in administering VTE prophylaxis after elective surgery (number of hours after recommended postoperative dose-time). Results: A total of 198 and 210 patients, pre- and postintervention, were evaluated, respectively. The median number of admission medication errors per patient declined from six pre-intervention to one postintervention ( p < 0.01). A total of 17 AEs were related to admission medication errors during the pre-intervention period compared with 1 postintervention. There were 54 and 63 elective surgery patients pre- and postintervention, respectively. The median delay in administering VTE prophylaxis for these patients declined from 9 h pre-intervention to 2 h postintervention ( p < 0.01). Conclusions: Pharmacist-assisted electronic prescribing reduced the number of admission medication errors and associated AEs.

scholarly journals Completeness of Medication Reconciliation by Pediatric Residents at Hospital Admission for Asthma

2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Ashley Martin ◽  
Jaime McDonald ◽  
Joanna Holland
Keyword(s):  
Hospital Admission ◽  
Medication Errors ◽  
Medication Reconciliation ◽  
Retrospective Chart Review ◽  
Drug Dose ◽  
Oral Drug ◽  
Medication History ◽  
Resident Physicians ◽  
Quality Improvement Interventions ◽  
Time Of Admission

Background: Medication errors at hospital admission, though preventable, continue to be common. The process of medication reconciliation has been identified as an important tool in reducing medication errors. The first step in medication reconciliation involves documenting a patient’s best possible medication history (BPMH); at the authors’ tertiary pediatric hospital, this step is completed at time of admission by resident physicians. Objectives: To describe and quantify the completeness of admission BPMH by resident physicians for pediatric inpatients with asthma. Methods: This single-centre, retrospective chart review evaluated documentation of admission medication reconciliation for pediatric inpatients with asthma who were admitted between January 2016 and December 2017. Medication reconciliation forms were deemed incomplete if records for asthma medications were missing drug name, inhaler strength or oral drug dose, directions for use, or evidence of reconciliation. Results: A total of 241 charts were evaluated, of which 97 (40%) had incomplete documentation for at least 1 medication; in particular, 48 (37%) of the 130 inhaled corticosteroid orders were missing inhaler strength. For most of the charts with incomplete medication history (68% [66/97]), no reason was documented; however, review of the medication reconciliation forms and physician notes revealed that families might have been unsure of a patient’s home medications or physicians might have left it to the pharmacy to clarify medication doses. Conclusions: Documentation of inhaler medications on admission medication reconciliation forms completed by resident physicians for pediatric patients with asthma was often incomplete. Future quality improvement interventions, including resident and patient education, are required at the study institution. Collaboration with pharmacy services is also likely to improve completeness of the medication reconciliation process. RÉSUMÉ Contexte : Bien qu’elles soient évitables, les erreurs de médication au moment de l’admission à l’hôpital sont encore répandues. Le processus du bilan comparatif des médicaments a été reconnu comme étant un outil important pour réduire ces erreurs. La première étape du bilan comparatif des médicaments vise à décrire le meilleur schéma thérapeutique possible (MSTP) du patient; dans l’hôpital pédiatrique tertiaire des auteurs, les médecins résidents se chargent de cette étape au moment de l’admission. Objectifs : Décrire et quantifier le degré d’exhaustivité du MSTP réalisé par les médecins résidents pour les patients en pédiatrie souffrant d’asthme. Méthodes : Cet examen rétrospectif unicentrique des dossiers a permis d’évaluer l’élaboration du bilan comparatif des médicaments à l’admission en pédiatrie des patients souffrant d’asthme entre janvier 2016 et décembre 2017. Les formulaires de bilan comparatif des médicaments étaient jugés incomplets si les dossiers relatifs aux médicaments contre l’asthme n’indiquaient pas le nom du médicament, la force de l’inhalateur ou la dose orale du médicament, le mode d’emploi ou les preuves de conciliation médicamenteuse. Résultats : L’évaluation portait sur 241 tableaux; au moins 1 médicament manquait dans la description de 97 d’entre eux (40 %); en particulier la force de l’inhalateur ne figurait pas dans 48 (37 %) des 130 ordonnances relatives aux corticostéroïdes administrés par inhalation. La plupart des tableaux dont l’histoire pharmacothérapeutique était incomplète (68 % [66/97]) n’en indiquaient pas la raison; cependant, l’examen des formulaires du bilan comparatif des médicaments et les notes des médecins ont révélé que les familles n’étaient peut-être pas certaines des médicaments que le patient prenait à domicile ou que les médecins auraient pu laisser aux pharmaciens le soin de clarifier les doses. Conclusions : La description des médicaments administrés au moyen d’inhalateurs au moment de l’admission, figurant sur les formulaires du bilan comparatif des médicaments remplis par les médecins résidents pour les patients en pédiatrie souffrant d’asthme, était souvent incomplète. De futures interventions sur l’amélioration de la qualité, y compris les instructions données au patient et au résident, sont nécessaires dans l’institution où s’est déroulée l’étude. Il est probable que la collaboration avec les services de pharmacie améliorerait l’exhaustivité du processus du bilan comparatif des médicaments.

scholarly journals Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491

2021 ◽  
Vol 18 (13) ◽  
pp. 6793
Author(s):  
Cristiano Ialongo ◽  
Antonella Farina ◽  
Raffaella Labriola ◽  
Antonio Angeloni ◽  
Emanuela Anastasi
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Time Series ◽  
Severe Acute Respiratory Syndrome ◽  
Time Series Analysis ◽  
Hospital Admission ◽  
The State ◽  
Series Analysis ◽  
Vitamin D Levels ◽  
Time Of Admission

We read with great interest the paper by Gaudio and colleagues on vitamin D and on the state of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of admission [...]

scholarly journals IgG acquisition against PfEMP1 PF11_0521 domain cassette DC13, DBLβ3_D4 domain, and peptides located within these constructs in children with cerebral malaria

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cyril Badaut ◽  
Pimnitah Visitdesotrakul ◽  
Aurélie Chabry ◽  
Pascal Bigey ◽  
Bernard Tornyigah ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Membrane Protein ◽  
Hospital Admission ◽  
Cerebral Malaria ◽  
Erythrocyte Membrane ◽  
Uncomplicated Malaria ◽  
Clinical Status ◽  
Severe Anemia ◽  
Specific Interactions ◽  
Time Of Admission

AbstractThe Plasmodium falciparum erythrocyte-membrane-protein-1 (PF3D7_1150400/PF11_0521) contains both domain cassette DC13 and DBLβ3 domain binding to EPCR and ICAM-1 receptors, respectively. This type of PfEMP1 proteins with dual binding specificity mediate specific interactions with brain micro-vessels endothelium leading to the development of cerebral malaria (CM). Using plasma collected from children at time of hospital admission and after 30 days, we study an acquisition of IgG response to PF3D7_1150400/PF11_0521 DC13 and DBLβ3_D4 recombinant constructs, and five peptides located within these constructs, specifically in DBLα1.7_D2 and DBLβ3_D4 domains. We found significant IgG responses against the entire DC13, PF11_0521_DBLβ3_D4 domain, and peptides. The responses varied against different peptides and depended on the clinical status of children. The response was stronger at day 30, and mostly did not differ between CM and uncomplicated malaria (UM) groups. Specifically, the DBLβ3 B3-34 peptide that contains essential residues involved in the interaction between PF11_0521 DBLβ3_D4 domain and ICAM-1 receptor demonstrated significant increase in reactivity to IgG1 and IgG3 antibodies at convalescence. Further, IgG reactivity in CM group at time of admission against functionally active (ICAM-1-binding) PF11_0521 DBLβ3_D4 domain was associated with protection against severe anemia. These results support development of vaccine based on the PF3D7_1150400/PF11_0521 structures to prevent CM.

scholarly journals Brain Metastases Research 1990–2010: Pattern of Citation and Systematic Review of Highly Cited Articles

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Carsten Nieder ◽  
Anca L. Grosu ◽  
Minesh P. Mehta
Keyword(s):  
Clinical Trials ◽  
Brain Metastases ◽  
Randomized Clinical Trials ◽  
Citation Rate ◽  
Prognostic Score ◽  
Median Number ◽  
Research Activity ◽  
Secondary Endpoints ◽  
Number Of Citations

Background. High and continuously increasing research activity related to different aspects of prevention, prediction, diagnosis and treatment of brain metastases has been performed between 1990 and 2010. One of the major databases contains 2695 scientific articles that were published during this time period. Different measures of impact, visibility, and quality of published research are available, each with its own pros and cons. For this overview, article citation rate was chosen.Results. Among the 10 most cited articles, 7 reported on randomized clinical trials. Nine covered surgical or radiosurgical approaches and the remaining one a widely adopted prognostic score. Overall, 30 randomized clinical trials were published between 1990 and 2010, including those with phase II design and excluding duplicate publications, for example, after longer followup or with focus on secondary endpoints. Twenty of these randomized clinical trials were published before 2008. Their median number of citations was 110, range 13–1013, compared to 5-6 citations for all types of publications. Annual citation rate appeared to gradually increase during the first 2-3 years after publication before reaching high levels.Conclusions. A large variety of preclinical and clinical topics achieved high numbers of citations. However, areas such as quality of life, side effects, and end-of-life care were underrepresented. Efforts to increase their visibility might be warranted.

The Prevalence and Nature of Medication Errors and Adverse Events Related to Preadmission Medications When Patients Are Admitted to an Orthopedic Inpatient Unit: An Observational Study

2018 ◽  
Vol 53 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Tim Tran ◽  
Simone E. Taylor ◽  
Andrew Hardidge ◽  
Elise Mitri ◽  
Parnaz Aminian ◽  
...  
Keyword(s):  
Adverse Events ◽  
Observational Study ◽  
Medication Errors ◽  
Medication Reconciliation ◽  
Median Number ◽  
Patient Harm ◽  
Prescribing Error ◽  
Delayed Treatment ◽  
Metropolitan Hospital ◽  
Orthopedic Patients

Background: Medication errors commonly occur when patients move from the community into hospital. Whereas medication reconciliation by pharmacists can detect errors, delays in undertaking this can increase the risk that patients receive incorrect admission medication regimens. Orthopedic patients are an at-risk group because they are often elderly and use multiple medications. Objective: To evaluate the prevalence and nature of medication errors when patients are admitted to an orthopedic unit where pharmacists routinely undertake postprescribing medication reconciliation. Methods: A 10-week retrospective observational study was conducted at a major metropolitan hospital in Australia. Medication records of orthopedic inpatients were evaluated to determine the number of prescribing and administration errors associated with patients’ preadmission medications and the number of related adverse events that occurred within 72 hours of admission. Results: Preadmission, 198 patients were taking at least 1 regular medication, of whom 176 (88.9%) experienced at least 1 medication error. The median number of errors per patient was 6 (interquartile range 3-10). Unintended omission of a preadmission medication was the most common prescribing error (87.4%). There were 17 adverse events involving 24 medications in 16 (8.1%) patients that were potentially related to medication errors; 6 events were deemed moderate consequence (moderate injury or harm, increased length of stay, or cancelled/delayed treatment), and the remainder were minor. Conclusion and Relevance: Medication errors were common when orthopedic patients were admitted to hospital, despite postprescribing pharmacist medication reconciliation. Some of these errors led to patient harm. Interventions that ensure that medications are prescribed correctly at admission are required.

CTNI-02. NERATINIB FOR TREATMENT OF LEPTOMENINGEAL METASTASES FROM HER2-POSITIVE BREAST CANCER IN EXTENDED ACCESS PROGRAM: PRELIMINARY RESULTS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi58-vi58
Author(s):  
Alessia Pellerino ◽  
Rosa Palmiero ◽  
Francesco Bruno ◽  
Erminia Muscolino ◽  
Federica Franchino ◽  
...  
Keyword(s):  
Median Time ◽  
Progression Free Survival ◽  
Median Number ◽  
Her2 Positive ◽  
Neurological Improvement ◽  
Extended Access ◽  
Heavily Pretreated ◽  
Secondary Endpoints ◽  
Radiological Response ◽  
Investigational Agents

Abstract INTRODUCTION The aim of the study was to evaluate the activity of neratinib in LM from HER2-positive BC after the failure of multiple lines of treatment. PATIENTS AND METHODS Inclusion criteria were as follows: age ≥ 18 years; histological diagnosis of primary HER2-positive BC; newly-diagnosed LM (LANO criteria); KPS ≥ 60; coexistence of BM that have or not received radiotherapy; life expectancy ≥ 3 months; previous drugs, including capecitabine, trastuzumab, T-DM1, pertuzumab, and hormone therapy, were allowed, with the exclusion of lapatinib or other investigational agents. Neratinib was administered 240 mg daily continuously. Primary endpoint was the OS. Secondary endpoints were progression-free survival (PFS), neurological benefit, radiological response rate, and tolerability. RESULTS Nine patients with LM have been enrolled with a median age of 44 years, and a median KPS of 80. Median time since LM onset from the diagnosis of primary BC was 42 months, and patients underwent a median number of adjuvant treatments before LM of 3. Three patients developed LM alone, and other 6 had LM associated with multiple BM. Six-months and 1-year OS were 66.7% and 22.3%, respectively, with a median OS of 8 months (95%CI 3-13*). Median PFS was 3.5 months (95%CI 2-6) after the start of treatment. A neurological improvement was reported in 2/9 patients (22.2%), while in other 4/9 patients (44.5%) was achieved a neurological stabilization lasting for a median time of 5 months (95%CI 2-19). The best radiological response was a stable disease in 5/9 patients (55.6%), while no complete or partial were achieved according to LANO criteria. A CSF clearance was observed in 1 patient only (11.1%). Grade III-IV adverse events were not reported, and 2 patients only (22.2%) had mild diarrhea correlated with neratinib. CONCLUSIONS Neratinib might be a safe and effective treatment in LM from heavily pretreated HER2-positive BC.

Abstract 150: Effect of Amplitude Spectral Area on Termination of Fibrillation and Outcomes in Pediatric Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Tia Raymond ◽  
Sandeep Pandit ◽  
Heather M Griffis ◽  
Xuemei Zhang ◽  
Richard Hanna ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Median Number ◽  
Spontaneous Circulation ◽  
Primary Endpoints ◽  
Pediatric Resuscitation ◽  
Spectral Area ◽  
Secondary Endpoints ◽  
Cardiac Illness ◽  
Illness Category

Introduction: Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and hospital survival in adults, but has not been studied during pediatric cardiac arrest (pCA). Hypothesis: We characterized AMSA during pCA from a pediatric resuscitation quality (pediRES-Q) collaborative and hypothesized that AMSA would be associated with TOF and ROSC. Methods: Children <18 years of age with pCA and VF were studied. AMSA was measured for 2 seconds prior to each shock and also averaged for each subject (AMSA-avg). TOF was defined as termination of VF 10 secs after defibrillation (DF) to any rhythm other than VF. ROSC was defined as >20 mins without chest compressions. Univariate and multivariable logistic regression analyses controlling for weight, current, and illness category (cardiac vs non-cardiac) were performed. Primary endpoints were TOF and ROSC without ECMO. Secondary endpoints were 24-hr survival and survival to hospital discharge. Results: Between 2015-2019, 50 children from 14 hospitals (median age 3.7 years [IQR 0.6, 13.1]; median weight 16.3 kgs [IQR 6.9, 37.2]; 46% male; 73% cardiac illness category) were identified. IHCA occurred in 47 children and OHCA in 3 children. We analyzed 111 shocks with median number of DFs 1.0 [IQR 1.0, 3.0], median DF energy dose 3.27 J/kg [IQR 2.65,5.01], median DF current 0.64 A/kg [IQR 0.38,0.96], median AMSA 12.21 [IQR 7.17,17.03], and median AMSA-avg 14.6 [IQR 8.6,19.2]. TOF was achieved in 72 DFs (65%), ROSC without ECMO in 31 (62%), ROC with ECMO in 11 (22%), 24-hr survival in 40 (80%), and survival to hospital discharge in 26 (52%). Weight (OR 0.91 [0.84, 0.99] P=0.025) and DF current (OR 1.44 [0.97, 2.2] P=0.07), but not AMSA, were significantly associated with TOF for the first shock. Controlling for DF current and illness category, there was a significant association between AMSA-avg (OR 1.11 [1.0, 1.24] P=0.044) and ROSC without ECMO. There was no significant association between AMSA-avg and 24-hr survival or survival to hospital discharge. Conclusions: In pediatric patients, TOF was associated with weight and DF current, but not AMSA, whereas AMSA-avg was associated with ROSC without ECMO, but not 24-hr survival or survival to hospital discharge.

scholarly journals Dealing with the COVID-19 pandemic in orthopaedics: experiences and procedure in Germany

2020 ◽  
Vol 1 (6) ◽  
pp. 309-315 ◽  
Author(s):  
Michael Mueller ◽  
Friedrich Boettner ◽  
Daniel Karczewski ◽  
Viktor Janz ◽  
Stephan Felix ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Clinical Symptoms ◽  
Elective Surgery ◽  
Infection Status ◽  
Clinical Experiences ◽  
Suction System ◽  
Free Zone ◽  
Orthopaedic Patients ◽  
Laminar Air Flow ◽  
Basis Class

Aims The worldwide COVID-19 pandemic is directly impacting the field of orthopaedic surgery and traumatology with postponed operations, changed status of planned elective surgeries and acute emergencies in patients with unknown infection status. To this point, Germany's COVID-19 infection numbers and death rate have been lower than those of many other nations. Methods This article summarizes the current regimen used in the field of orthopaedics in Germany during the COVID-19 pandemic. Internal university clinic guidelines, latest research results, expert consensus, and clinical experiences were combined in this article guideline. Results Every patient, with and without symptoms, should be screened for COVID-19 before hospital admission. Patients should be assigned to three groups (infection status unknown, confirmed, or negative). Patients with unknown infection status should be considered as infectious. Dependent of the infection status and acuity of the symptoms, patients are assigned to a COVID-19-free or affected zone of the hospital. Isolation, hand hygiene, and personal protective equipment is essential. Hospital personnel directly involved in the care of COVID-19 patients should be tested on a weekly basis independently of the presence of clinical symptoms, staff in the COVID-19-free zone on a biweekly basis. Class 1a operation rooms with laminar air flow and negative pressure are preferred for surgery in COVID-19 patients. Electrocautery should only be utilized with a smoke suction system. In cases of unavoidable elective surgery, a self-imposed quarantine of 14 days is recommended prior to hospital admission. Conclusion During the current COVID-19 pandemic, orthopaedic patients admitted to the hospital should be treated based on an interdisciplinary algorithm, strictly separating infectious and non-infectious cases. Cite this article: Bone Joint Open 2020;1-6:309–315.

Peri-Operative Eltrombopag or Immune Globulin for Patients with Immune Thrombocytopaenia (The Bridging ITP Trial): Methods and Rationale

2019 ◽  
Vol 119 (03) ◽  
pp. 500-507 ◽  
Author(s):  
Donald Arnold ◽  
Erin Jamula ◽  
Nancy Heddle ◽  
Richard Cook ◽  
Cyrus Hsia ◽  
...  
Keyword(s):  
Platelet Count ◽  
Randomized Trial ◽  
Immune Globulin ◽  
Elective Surgery ◽  
Dose Titration ◽  
Major Surgery ◽  
Open Label ◽  
Rescue Treatment ◽  
Minor Surgery ◽  
Secondary Endpoints

Background The Bridging ITP Trial is an open-label randomized trial designed to compare the oral thrombopoietin receptor agonist eltrombopag and intravenous immune globulin (IVIG) for patients with immune thrombocytopaenia (ITP) who require an increase in platelet count before elective surgery. Here, we report the study methods and rationale. Methods We designed a multi-centre, non-inferiority randomized trial comparing daily oral eltrombopag starting 3 weeks pre-operatively, and IVIG administered 1 week pre-operatively for patients with ITP requiring a platelet count increase prior to surgery. Starting dose of eltrombopag is 50 mg daily with a weekly pre-operative dose titration schedule, and treatment is continued for 1 week after surgical haemostasis is achieved. IVIG is administered at a dose of 1 to 2 g/kg 1 week pre-operatively with the allowance for a second dose within 1 week after surgical haemostasis. The objective of the study is to demonstrate non-inferiority of eltrombopag for the primary endpoint of achieving the pre-operative platelet count threshold (50 × 109/L for minor surgery; or 100 × 109/L for major surgery) and sustaining platelet count levels above the threshold for 1 week after surgical haemostasis is achieved, without the use of rescue treatment. Secondary endpoints include thrombosis, bleeding and patient satisfaction. Conclusion The Bridging ITP Trial will evaluate the efficacy and safety of eltrombopag as an alternative to IVIG in the peri-operative setting for patients with ITP. The protocol was designed to provide a management strategy that can be applied in clinical practice. ClinicalTrials.gov Identifier NCT01621204.

scholarly journals P15 Using prescribing nudges to reduce medication errors: paracetamol on paediatric intensive care

2020 ◽  
Vol 105 (9) ◽  
pp. e13.2-e14
Author(s):  
Jenny Gray ◽  
Nicole Aubrey ◽  
Emma Hipkin ◽  
Nicholas Jones
Keyword(s):  
Medication Errors ◽  
Undergraduate Students ◽  
Reduction Rate ◽  
Traditional Education ◽  
Electronic Prescribing ◽  
List Type ◽  
Training Methods ◽  
Dose Frequency ◽  
Prescribing Quality ◽  
Intravenous Paracetamol

AimParacetamol is widely available and its safety profile is relatively good. However, the risk associated with a paracetamol overdose is much greater in a neonate than that associated with an adult.In 2018, 8% of paediatric medication errors related to the use of paracetamol, including three 10x overdoses. These irregular but serious risks are difficult to manage over time due to degradation of heightened awareness. The aim of this project was to improve the prescribing quality of IV paracetamol on PICU and prevent recurrence of a 10-fold overdose by the implementation of multi-level changes.MethodElectronic prescribing (EP) has been in use on our unit since 2016. Small changes (prescribing nudges) in the configuration of the EP system can be used to improve prescribing quality. Forced functions, automation and standardisation have been found to be more effective in this than more traditional education and training methods.1 2The changes implemented in January 2019 were as follows:Forced function: All paracetamol prescriptions for patients under 1 year of age were capped at 180 mg (change from 1000 mg). The prescriber could not enter a number greater than 180 mg.Automation: All oral paracetamol prescriptions were changed to automatically prescribe 15 mg/kg 6 hourly regardless of age (previously 2 different options requiring the prescriber to input dose and frequency according to formulary directions).Standardisation/simplification: All oral paracetamol prescriptions were rationalised to a single option with automatic dose and frequency as above (previously 2 different options unnecessarily).Reminder/rule: A rule of ‘Consultant Approval’ was added to all intravenous paracetamol prescriptions. The intention of this was for a review of the prescription before use to ensure appropriate use and dose/frequency. This could not be forced, so an education package was launched across the unit by the quality improvement group.Prescription details were downloaded from the EP system for 3 month periods pre and post changes. he data was audited by pharmacy undergraduate students for prescribing accuracy.ResultsThe forced function, automation and standardisation options were implemented with 100% compliance. The ‘consultant approval’ rule was followed in 23% of cases. Consultant review led to a 58.6% reduction of IV paracetamol prescriptions on the unit and zero prescriptions for the first 2 months post implementation. The usage of oral paracetamol increased accordingly. This change corresponded to an overall reduction rate of 41.7% for intravenous paracetamol prescriptions.ConclusionsThis project demonstrates how changes that increase automation within prescribing can reduce error and that implementation is more successful than education. A limitation of our data analysis was that we did not measure the effect on pain relief or pain scores in the patients who did not receive IV paracetamol compared to those who did.ReferencesCafazzo JA, et al. From discovery to design: the evolution of human factors in healthcare. Healthcare Quarterly 2012; 15: 24–29.Patel Ms, et al. Nudge units to improve the delivery of healthcare NEJM 2018; 378: 214–216.

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