Wilson L S, Devitt P, Hally O
Department of Psychiatry of Old Age,St. Ita's Hospital,Portrane,Donabate,Co. Dublin,Ireland.
Ir J Psychol Med. 2015 Jun;32(2):197-204. doi: 10.1017/ipm.2014.58.
The aim of this study was to improve the quality of prescription writing in a long-term psychogeriatric inpatient unit by a combination of serial audits and interventions designed to address the identified deficiencies.
We undertook three clinical audits of the prescription sheets used in an inpatient unit providing continuing care for residents with severe and enduring mental illness and dementia. Based on the findings of the first audit a set of prescribing guidelines was implemented into the ward. Following the second audit a new prescription sheet was developed. The format of the new prescription sheet was designed to account for the needs of the unit and to adhere to Irish and UK best practise guidelines. Two months after its introduction we undertook a third audit.
Completion of the drug sensitivity box increased from 25% at audit one to 100% at audit three. Other specific aspects of prescription writing that had been poor at the beginning of the audit cycle also showed improvement: prescribing of generic psychotropic drugs increased by 69% and inclusion of the prescribers Medical Council Registration Number increased by 78%. However, some basic aspects of prescription writing remained weak such as frequency of drug administration and documentation of the stop/review date for 'as required' medication.
The results of this study suggest that clinical audit and feedback can improve the quality of prescriptions in an in-patient setting.
本研究旨在通过一系列审计和旨在解决已发现缺陷的干预措施相结合，提高长期老年精神科住院病房的处方书写质量。
我们对一个为患有严重和持续性精神疾病及痴呆症的住院患者提供持续护理的住院病房所使用的处方单进行了三次临床审计。根据第一次审计的结果，一套处方指南在病房实施。第二次审计后，开发了一种新的处方单。新处方单的格式旨在满足病房的需求，并遵循爱尔兰和英国的最佳实践指南。在引入新处方单两个月后，我们进行了第三次审计。
药物敏感性框的填写率从第一次审计时的25%提高到第三次审计时的100%。审计周期开始时处方书写方面其他较差的具体方面也有所改善：通用精神药物的处方增加了69%，开处方者的医学委员会注册号的填写增加了78%。然而，处方书写的一些基本方面仍然薄弱，如给药频率以及“按需”用药的停药/复查日期的记录。
本研究结果表明，临床审计和反馈可以提高住院环境中的处方质量。
