Student Dissertation

Agency : Prescription Review, Medication order and Administration Record sheet, Appropriateness of prescription

Objective : • To carry out baseline study before the introduction of intervention (prescription review by the consultants) • To implement prescription review by the consultants for internal medicine patients • To calculate the percentage compliance to prescription review by the consultants • To find out the relationship between the prescription review and errors in prescription writing

Background : Prescription Review is a technical review of the list of a patient’s medicines. It addresses issues relating to the prescription or medicines; the patient need not be present, nor does it require access to full notes. The medication review seeks to improve or optimize impact of treatment for an individual patient. The review is undertaken in a systematic and comprehensive way, by a competent person. Any changes resulting from the review are agreed with the patient. Patient safety is the ultimate goal for any Hospital. Prescription Review enables to improve the safety and quality of medication use. It ensures right medication in right dose at right time and right frequency. It helps to minimize the risk of Drug to Drug and Drug to Food interactions 62 proactively by eliminating any potential medication harm. Therefore it reduces drug error related morbidity and mortality. Prescription Review was initiated in In-patient department of the Internal Medicine department as a quality initiative. Moreover Prescription Review is a JCI requirement. Apart from reducing medication errors Prescription Review also reduce the treatment cost to the patients that may arise as a result of preventable medication errors. And more importantly these efforts will help gain patient trust and add on to patient satisfaction.

Methodology : • Study type - Interventional • Study duration – March to April, 2014 • Study area - 4th Floor and 1st Floor Nightingale ward of FMRI, Gurgaon The study was carried out in three phases. 1. First phase The first phase of the study was a baseline study for which only observation was done, no counseling or training were conducted. Procedure The data was collected from active patient records of the patients in the internal medicine on the audit checklist. The Audit tool had total of 15 parameters out of which 10 parameters were audited from MAR sheet (Medication order and Administration Record) and another 5 parameters were audited from progress note. The MAR sheet was filled by the residents .And the progress notes was filled by the consultants. The Audits were done daily for two weeks after the morning rounds by the consultants were over and the residents have transcribed the medicines on the MAR sheet. Hence the data was collected prospectively. Study Design • Study duration - 3rd March to 16th March, 2014 • Sample population - Prescription order of a particular date of all the patients of internal medicine (excluding ICU) during the study phase duration • Study tool - Audit checklist • Sampling method - Non Probability Sampling • Sampling type - Convenient Sampling • Sample size - 40 % of the total population.34 prescription orders were audited. Prescription order of a particular date was considered as a single opportunity and was considered as the basic unit for the study 2. Second Phase The second phase of the study had two components Preparation for training - The training modules were prepared for different stakeholders keeping in mind the training needs as well as the objective of the study. • Study duration – 17th March to 25th March, 2014 Training of the stakeholders - During this phase the intervention was introduced. All the stakeholders were sensitized about the need and importance of this new initiative. • Study duration – 26th March to 5th April,2014 3. Third Phase Procedure Last phase of the study is the observation phase in which the active files were audited for compliance to the prescription review and simultaneously the same files were also audited with the same check list that was used in the baseline study. The files were audited in the morning for the signature of the consultant on the MAR sheet which was supposed to be done the preceding evening. Study Design • Study area - 4th Floor and 1st Floor Nightingale ward of FMRI, Gurgaon • Sample population - Prescription order of a particular date of all the patients of internal medicine (excluding ICU) during the study phase duration • Study duration - 7th April to 24th April, 2014 • Sampling Method - Non Probability Sampling 63 • Sampling type - Convenient Sampling • Study tool - Audit checklist • Sample size – 40 % of the total population.83 prescription order were audited. Prescription order of a particular date was considered as a single opportunity and was considered as the basic unit for the study The data collected was analyzed to find out the relation between prescription review by the consultants and errors captured on the audit tool. • Study Duration - 25th to 27th April, 2014

Findings : The compliance to prescription review increased to 33 percent in the In-Patient department of the Internal Medicine. There was reduction in errors made while prescription writing in the Medication order and Administration sheet (MAR) sheet by the resident.

Recommendations : Prescription review enables to improve the medication safety. It helps to minimize the risk of Drug to Drug and Drug to Food interactions proactively by eliminating any potential medication harm. Therefore it reduces drug error related morbidity and mortality .This initiative can be extended to other departments also. Surprise audit and use of revised MAR sheet to ensure proper documentation of the process were used thereby assuring the sustainability of prescription review.


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