A Quality Improvement Initiative: Improving the Frequency of Inpatient Electronic Prescribing

A Quality Improvement Initiative to Reduce Prescription Error in a Pediatrics Outpatient Department at a Secondary-Level Community Hospital

Background Medication errors are common, especially by new trainees in primary care settings. Our study aimed at reducing the rate of prescription error in the pediatric outpatient department (OPD) of a secondary healthcare center in suburban north India using a quality improvement methodology. Methods Based on a survey and focused group discussion (FGD) involving all stakeholders, the identified problems and difficulties faced during outpatient prescriptions, interventions, and outcome parameters were drafted. The primary outcome measure was the prescription error rate evaluated by a senior resident (SR) of pediatrics, and the secondary outcome measures included the frequency of antibiotic prescriptions and investigations. Intervention Two cycles of Plan-Do-Study-Act (PDSA) were conducted on accessible drug formularies and standard treatment protocols for common pediatric conditions. Results The mean baseline prescription error was 72.2% (95% confidence interval (CI): 63.2-81.1). After the implementation of the first PDSA cycle, the mean error rate was 46.5% (95% CI: 36.6-56.5). There were eight consecutive points of prescription error below the control limit (63.2% and 81.1%) of the baseline. The PDSA-2 cycle showed the same shift to below the control limit (36.6% and 56.5%). The mean error rate found at the end of the PDSA-2 cycle was 22.5% (95% CI 15.7-29.5). There was no clinically significant difference in the number of investigations or antibiotics prescribed. Conclusion The application of standardized drug formularies and standard treatment protocols (STPs) can help reduce prescription errors, especially in a primary care setting. Expansion of such techniques to other centers could be particularly useful.

Professionals' Perception of a Strategy to Avoid Interruptions During Medication Handling

INTRODUCTION

The use of vests for handling medication (prescription, preparation, and dispensing) in the emergency department is a strategy designed to increase patient safety by reducing interruptions and, consequently, medication errors. In this study, we aim to assess how professionals perceive the use of vests in a pediatric emergency department of a tertiary hospital.

MATERIAL AND METHODS

A cross-sectional survey was conducted among pediatric emergency physicians and nurses in October and November 2019. We analyzed the results of a 19-item survey on the perception of vests as a tool for reducing interruptions and medication errors.

RESULTS

In this study, 91 surveys were delivered and 89 (97.8%) were completed. One hundred percent of the professionals were aware of the vests. Nurses reported the following reasons for not using the vest: high workload (25%) and preparation of nebulized and oral medications (25%). One hundred percent of doctors asked for the vest because of forgetfulness. Thirty-five physicians (81.4%) and 17 nurses (85.0%) said that wearing the vest, they were rarely or never interrupted. Eighty-two respondents (93.2%) agreed that vests are an effective strategy for minimizing medication errors.

CONCLUSIONS

Although medical professionals consider vests to be a useful strategy to prevent interruptions and reduce medication errors, adherence to the protocol is low, so a promotion strategy is needed to encourage professionals to use the vests.

Increasing the uptake of electronic prescribing in primary care

Electronic prescribing is a form of paperless prescribing that is reported to reduce prescription mistakes and increases the cost effectiveness of the process. In England, around 1.5 million prescriptions are generated in general practice daily. Thus by reducing costs and increasing efficiency of this system through electronic prescribing, costs can be driven down.

In this Quality Improvement project, a GP practice in London with approximately 3000 patients on record was assessed for its electronic prescribing rates throughout 3 intervention cycles over a period of 2 months. A baseline value of how many patients were already assigned to electronic prescribing was obtained and a period of normal change over a fortnight without any intervention was also assessed (an increase in 15 patients). These values were then used to illustrate any benefits of the interventions completed during the intervention cycles. An introduction of a new electronic prescribing form saw fortnightly uptake rates increase by 20%. The addition of leaflets and posters in the practice produced a decrease of 26% in fortnightly uptake rate. The final intervention included a staff meeting, computer notes to remind staff of electronic prescribing and attaching the new forms to paper prescriptions. This saw an increase in rates of 80% over two weeks. Overall, this project has illustrated that information provision of electronic prescribing needs to be more than just forms or posters. Indeed, the most effective way of improving rates relies on having a driven and motivated staff who are themselves well informed on electronic prescribing alongside adequate information placement for patients to access.

Tools and methods for quality improvement and patient safety in perinatal care

The quality of health care is now recognized to vary widely in all medical specialties, including perinatal medicine. A national focus on quality improvement (QI) and patient safety is prompting providers to change and improve the care given to patients. All QI and safety efforts require the use of an improvement model to manage the complex process of improving care. This article reviews the most common frameworks in use today, including the Model for Improvement, Six Sigma, and Lean. Specific tools such as affinity, key driver and fishbone diagrams, process maps and statistical process control, as well as checklists are reviewed, with examples from the perinatal literature to illustrate their use in perinatal QI efforts.