Audit and feedback to improve the quality of prescription writing

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Introduction: There is ample international evidence that poor quality prescription writing increases the risk of serious medication errors. Research has confirmed that didactic sessions and passive dissemination of guidelines are not effective means of modifying prescriber behaviour. Conversely, a combination of serial audit and feedback is known to be a successful technique for improving the quality of prescribing. The aim of this study was to design, implement, and evaluate a process of serial audits combined with feedback to prescribers, at both a general and individual level, to address the quality of prescription writing in an acute teaching hospital. Materials & Methods: A baseline audit of prescription writing quality was undertaken in September 2009. An awareness campaign was launched between November 2009 and January 2010 which promoted safe prescribing techniques by outlining acceptable prescribing standards and the risks of non-compliance with these. Standards for prescription writing were compiled and uploaded onto the medication safety intranet site to which staff were referred. Re-audits of the quality of prescription writing were undertaken in February and May 2010 and January 2011. Results: The process of audit and feedback resulted in an overall statistically significant improvement in allergy box completion between the baseline and the first and second re-audits, respectively. However, a rebound effect was observed between the second and third re-audits, where the trend towards improved compliance began to reverse. A statistically significant decline was observed in the percentage of prescribers non-compliant with forensic identity requirements between baseline and each subsequent re-audit. The percentage of prescriptions with omission of key medication-related data and the percentage of prescriptions deemed unclear decreased significantly between the baseline and each successive audit. A significant decrease was also observed in relation to the use of unapproved abbreviations between baseline and the first and third reaudits, respectively. Discussions, Conclusion: Audit and feedback proved to be a successful strategy in significantly improving the quality of prescription writing in our hospital in relation to a number of criteria. However, it is clear to the researchers that any improvements in the quality of prescription writing observed to date will only be sustained by an ongoing process of audit and feedback. The process of audit and feedback, although effective, was labour-intensive and requires high-level corporate and consultant support to be successful.

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