BackgroundPrescribing, dispensing and associated errors may cause serious consequences for patients, occasionally fatal. Reporting errors has significant educational benefits and is a part of risk management. We have found few examples of educational tools being used to increase reporting rates. It was also felt that the present rate of error reporting is inaccurate.PurposeTo increase the reporting rate of errors by the introduction of educational tools and to improve standards in prescribing.Material and methodsReporting data were collected over an initial 10 week period to create a baseline.There were three areas of reporting:internal pharmacy,pharmacy reporting on departments anddepartmental reports on the pharmacy.Three educational tools were then introduced: o project explanation (all areas); o prescription writing standards (physicians only); o anonymous reporting forms (all areas).Data were re-collected after a second 10 week period.ResultsInternal pharmacy reporting increased by almost 300%, mainly in two areas, ‘cytotoxics’ and ‘others’; the latter identified as mainly the incorrect use of equipment.Pharmacy reports on departments increased by 100% plus. The number of reports was also high.Departmental reports on the pharmacy increased by 30%. The majority were identified as basic administrative errors. The number of reports was low.Script errors increased by 140% from the first to the second period, but the total prescription numbers dispensed during the two periods did not significantly change.ConclusionThere has been a significant improvement in error reporting rates. All educational tools have contributed; anonymity and an increased awareness being considered as major contributors.The acceptance of the explanatory and education tools by some departmental staff was found to be difficult, and this may in part explain their low rate of reporting.A review of practice initiatives and improving the different methods of communication between departments are under way in order to improve standards and increase patient benefit.The increase in prescription errors may be due to three possibilities: (1) an increase in reporting; (2) an increase in errors; or (3) a combination of the two. Further investigation is required to explain the possibility of a decrease in prescribing standards.No conflict of interest.

BackgroundEach pharmacist has an ‘area’ of responsibility governed by specific guidelines. How performance indicators (PIs) can be used to audit work and to show continuous improvement is documented in the literature. However, the ability to identify ‘Performance concerns’ in pharmacists, is not well documented.PurposeTo show measurable improvement in the quality of service provision.To identify any pharmacist (s) with ‘performance concerns’.Material and methodsThe ‘audits‘ were performed by a pharmacist qualified in audit work. Three areas were audited – cytotoxic drugs, galenical preparation and narcotics. 52 PIs were used to score various procedures on a scale of 1–10 (1–2 unacceptable, 3–4 poor, 5–7 fair, 8–9 good, 10 excellent). 6 PIs were specific to prescription inaccuracies.The April 2014 audit covered the previous 3 months’ work. Audits were repeated in June and August 2014.Performance concerns may be indicated by no improvement in repeated audits and/or persistent low scoring PIs.ResultsThe April audit showed 73% PIs to be good-excellent, 18% fair in ‘Narcotics’. 71% PIs good-excellent, 21% fair in ‘Galenicals’. 41% good-excellent, 23% fair in ‘Cytotoxics’.The June audit showed 100% PIs to be good-excellent, 0% fair in ‘Narcotics’. 96% good-excellent, 0% fair in ‘Galenicals’. 71% good–excellent, 23% fair in ‘Cytotoxics’.The August audit showed 100% PIs to be good-excellent, 0% fair in ‘Narcotics’. 96% good-excellent, 0% fair in ‘Galenicals’. 71% good-excellent, 23% fair in ‘Cytotoxics’.The percentage of inaccurate prescriptions in all 3 areas during the audit period was 7–12%.ConclusionUsing PIs led to improved standards within an 8 month trial period.The area which improved least was cytotoxics. The reason has not been determined but this may indicate a performance concern, which requires further investigation.The rate of inaccurate prescriptions reflects an educational issue.Incorporating PIs into hospital departments would contribute to improving standards and would bring to light performance concerns in health care professionals.References and/or acknowledgementsNo conflict of interest.

Purpose Our objective was to identify modifiable factors related to inadequate AT in the EDOU by performing repeated point prevalence surveys (PPS). Material and methods PPS of all antimicrobial prescriptions for non-trauma patients admitted to the EDOU were performed daily for 5 consecutive weeks starting in February 2015. The main outcome variable was the rate of inadequate ATs, when any of the following criteria were not optimal according to local guidelines. Data included demographics, clinical assessment performed by the prescriptor (syndrome, source, severity at onset, type of acquisition), microbiological samples taken and antimicrobial prescriptions including the drug, dose and route of administration, if empirical or targeted, and mono or combination. Multivariate analysis was performed using logistic regression. Results Overall, 406 ATs were analysed. The most frequent syndromes were pneumonia (24%), urinary tract infections (22%) and non-pneumonic lower respiratory tract infections (22%); 51.5% (n=209) AT were inadequate (26% of them: drug with a reasonable spectrum was prescribed despite not being recommended as first line, 45% antibiotic not needed, 25% 'inadequate spectrum' and 4% others). In multivariable analysis, microbiological samples before AT (OR: 1.9; 95% CI: 1.2 to 2.8; p=0.004), specification of the source of infection in patient's charts (OR: 2.0; 95% CI: 1.1 to 4.2; p=0.05) and severe sepsis or shock (OR: 1.9; 95% CI: 1.2 to 2.9; p=0.003) were independent predictors of adequate AT. ConclusionHalf of the prescriptions were inadequate using very strict criteria. Interventions aiming at improving antibiotic use in this Unit should include education and promotion of optimal clinical procedures for antibiotic prescribing. Quality indicators such as taken micrrobiological samples and the description of source of infection in the medical chart were predictors of better AT.