Pilot of a National Inpatient Medication Chart in Australia: Improving prescribing safety and enabling prescribing training

Coombes, Ian D., Reid, Carol, McDougall, David, Stowasser, Danielle, Duiguid, Margaret and Mitchell, Charles (2011) Pilot of a National Inpatient Medication Chart in Australia: Improving prescribing safety and enabling prescribing training. British Journal of Clinical Pharmacology, 72 2: 338-349. doi:10.1111/j.1365-2125.2011.03967.x

Author Coombes, Ian D.
Reid, Carol
McDougall, David
Stowasser, Danielle
Duiguid, Margaret
Mitchell, Charles
Title Pilot of a National Inpatient Medication Chart in Australia: Improving prescribing safety and enabling prescribing training
Journal name British Journal of Clinical Pharmacology   Check publisher's open access policy
ISSN 0306-5251
Publication date 2011-08-01
Sub-type Article (original research)
DOI 10.1111/j.1365-2125.2011.03967.x
Volume 72
Issue 2
Start page 338
End page 349
Total pages 12
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
• Prescribing errors are common and are caused by multiple factors. Standard medication charts have been recommended by British and Australian Health services. A study of a standard medication chart in five hospitals in one state of Australia significantly reduced prescribing errors.

• A standard medication chart developed in one area can be adopted through a collaborative process and successfully implemented across a diverse country resulting in similar reductions in prescribing errors. Three of the four stages of the prescribing process (information gathering, decision making and communication of instructions) can be improved by the use of an improved standard medication chart. The introduction of a standard medication chart has enabled development of standard prescribing education programmes.
AIMS To establish whether a standard national inpatient medication chart (NIMC) could be implemented across a range of sites in Australia and reduce frequency of prescribing errors and improve the completion of adverse drug reaction (ADR) and warfarin documentation.
METHODS A medication chart, which had previously been implemented in one state, was piloted in 22 public hospitals across Australia. Prospective before and after observational audits of prescribing errors were undertaken by trained nurse and pharmacist teams. The introduction of the chart was accompanied by local education of prescribers and presentation of baseline audit findings.
RESULTS After the introduction of the NIMC, prescribing errors decreased by almost one-third, from 6383 errors in 15 557 orders, a median (range) of 3 (0–48) per patient to 4293 in 15 416 orders, 2 (0–45) per patient (Wilcoxon Rank Sum test, P < 0.001). The documentation of drugs causing previous ADRs increased significantly from 81.9% to 88.9% of drugs (χ2 test, P < 0.001). The documentation of the indication for warfarin increased from 12.1 to 34.3% (χ2 test, P= 0.001) and the documentation of target INR increased from 10.8 to 70.0% (χ2 test, P < 0.001) after implementation of the chart.
CONCLUSIONS National implementation of a standard medication chart is possible. Similar reduction in the rate of prescribing errors can be achieved in multiple sites across one country. The consequent benefits for patient care and training of staff could be significant.
Keyword Medication charts
Prescribing education
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Pharmacy Publications
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