LAUSR

Aims Prescribing errors are the most common form of medication errors with potential to cause harm, especially in paediatrics. Majority of prescribing is done by junior doctors, some with little paediatric experience. Previous audits highlighted high incidence of errors but lost momentum following change in junior doctors. The aim of our project was to measure inpatient prescription errors, identify the most common drug errors, and implement interventions to reduce these. Methods An enthusiastic multidisciplinary team including doctors, pharmacists, nurses and physician’s assistant (to provide continuity) used The Model for Improvement to test interventions according to errors noted. The importance of the project was communicated to all paediatric trainees (by email/face to face teaching) and ward nursing staff. Safe prescribing sessions were emphasised during induction of different junior doctor groups. Our ward pharmacist assessed all drug charts of inpatients for two days each week collecting data on error rate and drugs involved. PDSA cycles from April 2017 tested versions of a weekly ‘Druggle’ where an observed drug error was highlighted by pharmacist to all members of the ward multidisciplinary team following ward safety huddles, with interactive ‘Spot the Error’ sessions. A (P) outlining the Druggle was displayed in the doctors’ office and emailed weekly to junior doctors with learning points/reminders. Junior doctors designed a prescribing checklist and requested anonymised pictures of errors on (P)s. Results There was an improvement in prescribing errors following introduction of Druggles in week 3 and a prescribing checklist in week 7, illustrated on annotated run charts for 20 weeks with 7 consecutive points below the median of 17.9%. Incorrect prescribing of Ibuprofen was responsible for 58% of wrong dose calculations in the first 12 weeks. Interventions to improve this (dedicated Druggle, email to junior doctors, nurse education), resulted in a drop to 0% in the subsequent 7 weeks. Conclusion Identification of common prescribing errors, weekly Druggles, and empowering nursing staff to identify errors have all contributed to improved prescribing. The project is ongoing, with plans to give individual feedback on errors along with shared learning, to broaden interventions to include other specialties, and to ensure the improvements are sustained.