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Minimising prescribing errors in the ICU

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Introduction

We aimed to audit the prescribing practice on a busy 14-bedd general ICU, and develop standardised practices and tools to improve safety. Prescribing errors occur as commonly as in 10% of UK hospital admissions, costing 8.5 extra bed days per admission, and costing the National Health Service an estimated £1 billion per annum [1]. The majority of these mistakes are avoidable [2].

Methods

We audited the daily infusion charts of all patients in three separate spot checks, over 1 week. We assessed all aspects of prescriptions that make them legal and valid, in accordance with national guidance [3]. New procedures were introduced, which included a standardised prescription sticker, with common, preprinted, infusion prescriptions on (noradrenaline, propofol, and so forth), and education on using the new prescription stickers. A month later the audit process was repeated.

Results

We assessed 129 prescriptions in the first round, and 111 after intervention, demonstrating a 70% improvement in safe prescribing. Only 24% of prescriptions initially fulfilled best practice criteria, improving to 94% afterwards. We also reduced the number of infusions running without prescription, 7 (6%) versus 24 (19%). See Figures 1 and 2.

Figure 1
figure1

Accuracy of prescriptions before intervention.

Figure 2
figure2

Accuracy of prescriptions after intervention.

Conclusion

Our audit supports the need for standardised prescribing practices within critical care, especially when dealing with potentially harmful vasoactive/sedative drugs. With a small, cost-effective intervention (£20 for 6,200 stickers), we improved prescribing accuracy, and thus patient safety in intensive care.

References

  1. 1.

    Vincent , et al.: Adverse events in British hospitals. BMJ 2001, 322: 517-519. 10.1136/bmj.322.7285.517

  2. 2.

    Building a Safer NHS for Patients: Improving Medication Safety[http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4071443]

  3. 3.

    Safe Prescribing[http://www.medicalprotection.org/uk/england-factsheets/safe-prescribing]

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Author information

Correspondence to DJ Melia.

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Melia, D., Saha, S. Minimising prescribing errors in the ICU. Crit Care 18, P1 (2014). https://doi.org/10.1186/cc13191

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Keywords

  • Noradrenaline
  • Hospital Admission
  • Patient Safety
  • Critical Care
  • Standardise Practice