Does a Hospital Formulary Influence Prescribing Practice in an Acute Medical Admissions Unit?

Prescription quality in an acute medical ward

PURPOSE

Prescribing is an effective and economical means of delivering health care. The aim of this study is to assess the quality of prescriptions in an Acute Medical Assessment Unit (AMAU) at Aberdeen Royal Infirmary (ARI).

METHODS

Prescription data were collected from all available medication charts of patients admitted to the ward over a 2-week period. Prescription quality indicators were divided into two categories: prescription chart related (e.g. complete patient information and absence of drug-drug interactions (DDIs)) and medication related (e.g. legibility of handwriting, generic prescribing and adherence to hospital's formulary).

RESULTS

Patient identifiers were omitted in 4% (n = 8) of the medication charts included in assessing prescribing quality. Patient allergies were omitted in 36% (n = 76) of charts. At least one DDI was detected in 26% (n = 55) of the charts. The mean number of medications prescribed per patient was seven (95%CI, 6.53-7.65). The median number of medication-related prescribing errors per medication chart was two (interquartile range (IQR), 1-3). The distribution of these errors was significantly higher in charts with five or more medications (p < 0.001).

CONCLUSION

This study demonstrates a relatively acceptable level of prescription quality compared to the published literature. However, the number of DDIs and level of allergy documentation are of concern emphasising the need for continued education in this field.

Description of a Chronic Heart Failure Service Model and Review of Pharmacotherapy in a District General Hospital in Comparison to Scottish Intercollegiate Guideline Network (SIGN) Guidelines

Background

The Scottish Intercollegiate Guidelines Network (SIGN) guideline 95 on the management of chronic heart failure (CHF) was published in February 2007, superseding SIGN guideline 35 of February 1999. The guideline promotes evidence based management of CHF.

Aims

To describe an existing service model and to review our level of concordance with SIGN guidelines.

Methods

We describe a model of a CHF service based in a district general hospital (DGH) in Scotland. We conducted a retrospective review on consecutive new referrals between August and November 2002, and a prospective review of new attendances between September 2005 and January 2006.

Results

In 2002 and 2005/6, 49 and 45 patients were reviewed respectively, with 26 and 28 patients showing left ventricular systolic dysfunction on echocardiography. Median ages of patients were 81 and 79 years respectively. Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin II Receptor Blocker (AIIRB) therapy was in use in 23 (88.5%) and 24 (85.7%) patients respectively. The use of β-blockers, digoxin and spironolactone was shown to have improved between both reviews.

Conclusions

We have been able to demonstrate an improving level of concordance with SIGN guidelines in a district general hospital (DGH) heart failure service model run by care of the elderly physicians and supported by specialist nurses.