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Background Generic Prescribing is an essential component of prescribing, however it is often overlooked. Use of brand names can led to poor recognition of the correct medications. It can also led to medication error. It is part of the policy of our hospital group that generic prescribing is used at all times. We performed a similar audit in 2018 and 79% of drug kardexes had brand names used. Prescribing education is an integral part of NCHD teaching. We wished to re-audit to determine rates of generic prescribing now. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. Each drug was reviewed and if any prescription had brand names, the entire kardex was deemed non-compliant. Results 285 Drug kardexes were assessed across 14 separate wards. 41% were on surgical wards, 59% were on medical wards. 31 (11%) of kardexes had complete generic prescribing. Only 3 kardexes on the surgical ward had complete generic prescribing. Conclusion The low rates of generic prescribing remain an issue in our university teaching hospital. A similar audit was performed in 2018 with average rates of 20% of generic prescribing. This has decreased in the last year. The failure to generic prescribe puts patients at risk of medication error and also increases cost to the HSE. Education on prescribing is part of the NCHD induction, however, 9 months on there continues to be issues with compliance with generic prescribing. Education alone is not enough to improve current practice. The use of e prescribing offers the potential to alleviate this problem.

Background Medication records are essential components of patient care and a source of medical error. The HSE Code of Practice for Healthcare Records Management has highlighted criteria which must be complied with in these records. In the HSE Clinical Strategy and Programmes Division, “Test your care” is used to promote a code of practice and a set of metrics which need to be adhered to. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. We assessed the drug kardexes based on 9 different metrics. (Generic names used, capital letters used, start date recorded, legible dosing, route and frequency of medication documented, minimum dosing documented, legible prescriptions and discontinued drugs crossed off) Results 285 drug kardexes were reviewed. No drug kardex was fully compliant with the 9 standards. The main deficits were in relation to use of brand names, no documentation of frequency and omission of IMC numbers. The average number of metrics met was lower on surgical wards than medical wards - 3.6 vs 4.7 respectively, and this difference was statistically significant (p< .00001; 2 sample t test). Conclusion The universal poor compliance with these standards highlights both the poor design of the current drug kardex and poor awareness with prescribers of these standards. In the current drug kardex, there is no dedicated space for frequency or IMC number and therefore these are often forgotten. The use of brand names consistently highlights poor prescribing practice and more education is required to improve this. We plan to improve current prescribing education sessions for all doctors to highlight the current deficiencies and to increase compliance with standards.

Background Illegible prescribing can lead to medication error and adverse drug reactions. The HSE Standards and Recommended Practices for Healthcare Records Management and the Practice Standards and Guidelines for Nurses for Prescriptive Authority have highlighted criteria which should be adhered to in relation to prescribing. We set out to audit compliance with these standards in relation to legibility of prescriptions in an Irish University Teaching Hospital. Methods Over a 48 hour period, drug kardexes were reviewed on 14 separate in-patient wards. Legibility was judged by a single assessor on each ward. A drug kardex was deemed legible if all of the following criteria were met: The chi squared test was used to determine the significance of the difference in proportions for categorical variables. Results 285 drug kardexes were reviewed over the 48 hour period. 41% were on surgical wards, 59% were on medical wards. The median patient age was 70 (IQR:55-78), and 56% were male. 48% of drug kardexes were deemed legible. A higher proportion were deemed legible on medical wards compared to surgical wards (68% vs 19% p<0.05). Upper case was used in 13% of kardexes, with similar proportions on medical and surgical wards. Conclusion Poor legibility of drug kardexes may increase risk of medication errors and adverse drug reactions. We plan to commence targeted prescribing education sessions to highlight the current deficiencies and improve current practice. Changes to kardex layout may also aid legibility. Long term planning for electronic prescribing would also help resolve issues in this area.