Standardised Chart Aims to Reduce Prescribing Errors
Friday, April 4th, 2014
on behalf of Healthcare Improvement Scotland
A standardised prescribing and administration chart – developed over the last two years by the Royal College of Physicians of Edinburgh (RCPE) and Healthcare Improvement Scotland – is to be tested in three NHS Boards as a measure to try to reduce prescribing errors (wrong dose or wrong drug) by medical and other staff.
The creation of a national chart follows recent research that showed that around 7% of prescriptions written in Scottish hospitals contained an error, a rate that is similar to previous studies in England and internationally ( see link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880263/)
The study highlighted that avoidable errors were often caused by busy trainee doctors – who are typically responsible for more than 50% of written prescriptions. Having to deal with different charts while on rotation to different hospitals is a contributing factor.
Trainees doctors who made errors cited workload and time pressures as important causes for prescribing mistakes.
A standardised chart – which has been co-designed with doctors, pharmacists and nurses – will provide a simpler and more familiar document consistent across all hospitals and wards.
The standardised chart is to be tested in Tayside, Western Isles and Highland NHS Boards from April with the hope that, subject to successful evaluation, it can be implemented nationally in Scotland.
LACK OF CONSISTENCY
Prof Simon Maxwell, Professor of Student Learning – clinical pharmacology and prescribing, University of Edinburgh, and Chair of the RCPE Working Group which developed the chart, said:
“Despite significant improvements in patient safety in recent years, prescribing errors remain a cause for concern in all hospitals and can be caused by many factors. One of these has been the historical development of local prescribing and administration charts by NHS Boards, each with their own layout and standards for completion. This lack of consistency has created problems for trainee doctors and nurses who might move many times during their training. Furthermore, those of us charged with training medical students cannot predict which chart they are likely to be using when they qualify. By developing a national standardised chart, we believe we have provided a low cost and effective solution which will be to the benefit not only of staff but also the patients they treat. Similar national charts have also been adopted and proved successful in Wales and Australia.”
Prof Derek Bell, President of the Royal College of Physicians of Edinburgh, said:
“We have long advocated the need for a national prescribing and administration chart to improve patient care in Scotland. We believe this standardised documentation will reduce variation and create a common language with common processes for staff. This will reduce errors, improve patient safety and better support medical teams. We are delighted the chart is entering its formal testing and evaluation phase. This is essential to ensure that the chart is effective in clinical environments and is fit for the future.”
Dr Brian Robson, Executive Clinical Director at Healthcare Improvement Scotland said the success of the partnership with RCPE is a key example of the benefits of a joined up strategy to support the drive to improve patient care.
He said: “This initiative enhances our goal to ensure Scotland has the safest and best hospitals in the world.
“Our Scottish Patient Safety Programme is already acknowledged as a world leader in its commitment to implement a range of initiatives to reduce harm to patients– and projects of this nature ensures we are continually striving to be best.
“We know other health authorities around the world will be closely following the results of this test.
“I’m looking forward to seeing the impact that this standardised chart will bring to the NHS, doctors – and most importantly, patients.”
Theresa Fyffe, Director RCN Scotland, said:
“The RCN commends the Royal College of Physician of Edinburgh and Healthcare Improvement Scotland for taking the initiative to standardise adult in-patient prescription charts in Scotland. Medication administration is an important nursing task and demanding workloads, combined with increased volume and complex prescribed medication, can increase the risk of medication errors. A standardised chart will support a consistent approach to medication record keeping, reducing variations in practice and errors and enhancing patient safety.
“The RCN has supported the call for the right record to be captured once for the right patient (RCN 2013). This initiative – which proposes to streamline processes for capturing accurate records – will improve nursing practice. We hope the results of the pilot of this prescription chart with three NHS Health boards in Scotland will help with the introduction and adoption of a ‘fit-for-purpose’ chart.”
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