An Audit to Assess Adherence to Hospital Prescribing Guidelines in a Tertiary Paediatric Intensive Care Unit

Abstract

Aims The aims of the audit were to:Assess the level of adherence to hospital prescribing guidelines in the Paediatric Intensive Care Unit (PICU). Identify the areas of greatest and least adherence. Identify any possible patient factors that could impact on prescribing adherence levels. Methods A prospective, observational audit of all prescription items written each day, for patients newly admitted to and remaining on PICU during a two week audit period. Patient prescriptions were reviewed at the bedside and prescribing adherence information was captured using a data collection sheet. The data collection sheet was developed to ensure that recommendations dictated by hospital prescribing guidelines were audited. Additional patient data was also collected, in order to determine whether there were any patient factors that could influence the degree of prescribing adherence and consequently the level of prescribing errors. Arch Dis Child 2014;99:e3 7 of 21 Abstracts group.bmj.com on March 22, 2015 -Published by http://adc.bmj.com/ Downloaded fromResults Data was collected for 50 patients during the audit period. 988 prescription items were reviewed, comprising a mean of 20 prescription items per patient, with a mean of 24 drug administrations per patient over a 24 hour period. The audit showed an overall adherence level of 91.62% to prescribing recommendations. No correlation was demonstrated between prescribing adherence and patient factors such as the patient's Paediatric Multiple Organ Deficiency Score (P-MODS). Prescribers had 100% adherence to the recommendation to record the patient's weight on the front of the prescription chart, but only a 14% compliance level with the recommendation to record the date of discontinuation of a drug. During the audit period the level of reported PICU errors entered onto the hospital critical incident database were 5.06 errors per 1000 prescription items; none of these reported errors caused permanent harm to patients due to staff vigilance allowing early detection and avoidance of harm.Conclusions The audit demonstrated that there is currently a high level of adherence to prescribing recommendations by prescribers in PICU. However, the audit has identified areas and prescribing practices that can be targeted in order to further improve adherence levels for prescribers working in the challenging environment of PICU. REFERENCES 1 Wong IC, Ghaleb MA, Franklin BD, et al. Incidence and nature of dosing errors in paediatric medications: a systematic review.

Evaluation of a pharmaceutical assessment screening tool to measure patient acuity and prioritise pharmaceutical care in a UK hospital

“…Adherence to clinical practice guidelines in healthcare is extremely variable ranging from 4.5% for handwashing guidelines14 to 91.6% for prescribing guidelines in a paediatric ICU 15. The adherence rate for this patient acuity tool had been expected to be on the order of 80%, which was in line with internal audits of adherence to the departmental pharmaceutical care guidance.…”