5PSQ-191 New general drug chart, post-implementation clinical audit

Abstract

Background and importance A new general drug chart was introduced in May 2019. The chart was developed in response to medication incidents and in line with national medication record templates. The new drug chart has a new configuration and format for prescribing. Changes include dedicated sections for anticoagulants and antimicrobials and a venous thromboembolism and bleeding risk assessment (VTE-RA) tool, which was previously available on the hospital intranet. Aim and objectives To assess the implementation of this change in prescribing practice. Material and methods A data collection form was designed using the hospital’s ‘prescribing and drug administration standards’. This document describes how prescribers and nursing staff are to use the drug chart. Guidelines include where to prescribe specific medication, use of abbreviations and general best practice guidelines. Data were collected by nurse and pharmacist volunteers in September 2019. A target sample size of approximately 275 patients was chosen as this equates to half of the inpatients. A convenience sample was collected. Data collectors were assigned to collect data on specific wards until the target sample number was reached. Anonymised data were analysed by pharmacy staff using Microsoft Excel. Descriptive statistics were calculated. Results 273 drug charts were reviewed. An average of 16 medicines were prescribed per patient (range 1–41). 75% (n=204) of patients were prescribed an anticoagulant, however, only 3% (n=8) of patients had the VTE–RA tool completed by the medical team. The majority of anticoagulant (99.5%) and antimicrobial (95%) prescriptions were written in the correct section. The surgical antimicrobial prophylaxis (SAP) section was used in 42% (n=11) of applicable cases. For patients prescribed an antimicrobial requiring therapeutic drug monitoring (TDM), the correct section was always used. Completion of target and attained levels was documented for 38% and 35% of patients on TDM antimicrobials, respectively. Documentation of ‘proposed duration’ and ‘clinical indication’ for antimicrobials was 25% and 50%, respectively. Conclusion and relevance The new general drug chart is being used in line with hospital standards in most instances. Topics that could be targeted for improvement include the use of the SAP section, documentation of target/attained levels of TDM antimicrobials and specifying ‘proposed duration’ and ‘clinical indication’ for antimicrobials. Research on the appropriate completion of the VTE-RA tool is currently underway. References and/or acknowledgements Conflict of interest No conflict of interest