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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.

Introduction Pulmonary embolism (PE) is a leading cause of cardiovascular morbidity worldwide. The risk of early death in the setting of untreated PE may be as high as 30%. However, diagnostic and therapeutic advances in recent years have led to a progressive decline in global PE-related mortality and recent data describing rates of in-hospital death following PE suggest a mortality rate of approximately 5-15%. Moreover, strategies directed at stratification of PE severity have been shown to safely identify a sub-group of low-risk patients (up to 30-50% of all patients) for whom outpatient management is feasible without the need for hospital admission. Avoiding hospitalisation for low-risk PE patients is associated with improved patient satisfaction and avoids exposing patients to the risks associated with hospital admission. Ambulatory PE management would also be predicted to lead to significant healthcare cost-savings. However ambulatory care models for low-risk PE appear to be under-utilised despite these potential benefits. Barriers to implementation include access to outpatient follow-up services and the perceived risks associated with this model of care. The Ireland East Hospital Group (IEHG) is the largest hospital network in the Republic of Ireland, consisting of 11 hospitals (including large academic centres, community general hospitals and the national maternity hospital). The IEHG serves a population of over 1.1 million individuals. We sought to determine the frequency of admissions to hospital with PE and to assess key outcomes, including length-of-stay (LOS) and in-hospital mortality within this population. Methods Data pertaining to PE diagnosis from January 2018 to December 2020 were obtained from NQAIS Clinical (National Quality Assessment and Improvement System; an electronic reporting tool which is populated with anonymised data extracted from the hospital in-patient enquiry system). This system compiles diagnostic data on all patients by ICD-10 code at the time of discharge. For the purposes of this analysis the ICD-10 codes I26.0 and I26.9 were used to identify patients with PE and only admission episodes where PE was the primary diagnosis were included; cases of 'secondary PE' (historical PE or hospital-acquired) were excluded. Projected population figures, extrapolated from Census 2016 data, were obtained from Health Atlas Ireland (an open-source application providing access to datasets developed by the Health Intelligence Unit of the Health Service Executive of Ireland). Results During the 3-year study period, 958 in-patient episodes occurred where PE was recorded as the primary diagnosis, corresponding to an incidence of 0.37 per 1000 adults per annum (95% CI 0.35 to 0.40). The incidence was highest in the over 85 years age-group (1.07 per 1000 per annum; 95% CI 0.80 to 1.33). PE was more common in women in all age-groups apart from the 46-65 years age group [males: 0.51 (95% CI 0.44-0.51) vs females: 0.36 (95% CI 0.3-0.42) per 1000]. In 82.7% of episodes, the ultimate discharge destination was to home. In 5.3% the discharge destination was a nursing home and 4.6% were transferred to another hospital. The all-cause in-hospital mortality rate was 3.1% (30 fatalities; 18 females, 12 males). Most deaths occurred in the 66-85 years age-group (n=14), with 9 fatalities in the age &gt;85 years group and 7 fatal PE events in the 46-65 years age-group. Average hospital LOS was 7.8 days. 8.9% of inpatient episodes resulted in same-day discharge. In 55.9% of episodes, discharge occurred after day 4. Those discharged to home had an average length of stay of 6.31 days, while patients awaiting nursing home facilities averaged 26.5 days. Conclusion The incidence of acute presentation with PE within this population is consistent with international reports. The rate of in-hospital mortality compares favourably with these international standards. The mortality rate may reflect improvements in PE care but may also reflect the inclusion of a significant number of 'low-risk' individuals in the analysis (many of whom may have been suitable for outpatient management). The mortality rate might also reflect increased detection of small, low-risk distal PE (as a result of advances in diagnostics). In any event, these data suggest that more widespread implementation of outpatient PE management is likely to be feasible and would represent an opportunity for improved resource utilisation. Disclosures Ni Ainle: Leo Pharma: Research Funding; Actelion: Research Funding; Daiichi-Sankyo: Research Funding; Bayer Pharma: Research Funding. Kevane: Leo Pharma: Research Funding.