SummaryThis prospective, time series, cross-sectional study was designed to compare the quality of handwritten vs computerised prescriptions in a tertiary 25-bedded cardiothoracic intensive care unit. A total of 14 721 prescriptions for 613 patients were analysed over three periods of investigation: 7 months before; and 5 and 12 months after implementation of a clinical information system with computerised physician order entry capability. Errors in prescribing were common. Only (53%) of handwritten charts analysed had all immediate administration drugs prescribed correctly.

Much attention has focused upon the adverse effect of medication errors on patient safety. Medication errors are common in ICUs [1], and may be even more frequent in cardiothoracic units because of the large number of medications prescribed and the rapid turnover of patients. Errors can occur because of legibility and completeness of orders during prescribing. This study compares the quality, including completeness and legibility, of handwritten medication orders versus computerised physician order entry (CPOE) in a cardiothoracic ICU, as well as quality of the audit trail in relation to administration. MethodsThe study was a prospective, time series, cross-sectional audit, conducted in three phases. Every prescription for every patient in the ICU for two consecutive weeks at 7-months pre-implementation then at 5-and 11-months postimplementation of a clinical information system was examined. ResultsOver the 6 weeks of study of the three periods, 14 721 prescription orders were analysed, in 613 patients. The CPOE system eliminated all issues of legibility and completeness (Table 1). Previously, only 31% of signatures were legible. A small fall in completion of the intra-operative information was initially observed (97.3-92.6%) but this had risen to 99% by the end of the study. There was a change in proportion of drug prescribed in favour of 'regular' prescriptions, rising from 61% to 80% of all prescriptions. The average pharmacy cost per patient fell from £100.16 to £76.74 per patient after introduction of CPOE, irrespective of bed occupancy. DiscussionCPOE implementation dramatically improved the quality, including completeness and legibility, of prescription and record of administration. The medication process has been made safer and information is more complete whilst drug costs have been reduced. Implementation of CPOE throughout all cardiothoracic ICUs could benefit patient safety.Reference

ObjectiveHigh-dose tranexamic acid (TXA) can cause seizures in patients who have undergone pulmonary endarterectomy (PTE). Seizures secondary to TXA will resolve once the drug is excreted from the body, and the patients do not have to be on long-term anticonvulsants. The aim of the study is to find out if medication review in the hospital has led to deprescribing of anticonvulsants for TXA-associated seizures on discharge from the critical care unit (CCU) and hospital.MethodsThis is a single-centre retrospective study conducted at a tertiary cardiothoracic hospital between 2012 and 2017. The inclusion criteria consisted of all adult patients who have undergone PTE surgery. Patients who were started on anticonvulsants preoperatively or postoperatively for seizures secondary to organic causes were excluded.ResultsA total of 933 patients underwent PTE from January 2012 to August 2017. 25 patients had TXA-related seizures postoperatively and were started on anticonvulsant therapy, giving an incidence of 2.7%. 15 patients were discharged from the CCU without anticonvulsants. A further three patients had their anticonvulsants deprescribed in the ward before being discharged from the hospital.ConclusionDeprescribing of anticonvulsants after benign seizures secondary to high-dose TXA is facilitated by verbal and written handover, which can be improved in our hospital. A detailed handover summary, as well as a discharge letter with clearly defined instructions for drug review, is needed to make deprescribing a more robust process.