Improving prescribing of non-steroidal anti-inflammatory drugs in hospital: an educational approach.

An assessment has been undertaken of the effect of an educationally-based voluntary prescribing policy on the overall prescribing of NSAIDs in two acute hospital units. The policy engendered a fall in district expenditure on these drugs of 12% over 1 year. The long term impact of the policy was studied after 3 years within one area of hospital prescribing, the Accident and Emergency (A & E) department. At the time of formal appraisal, a high degree of compliance with the agreed policy, of greater than 95%, was being maintained. The effect of regular audit sessions between prescribers, specialist clinicians and pharmacists was studied in detail over a period of 30 weeks. A reduction in total NSAID prescribing of 40% was achieved after a single session. A change in junior medical staff was associated with a fivefold increase in prescriptions for NSAIDs, which was not sustained. Total A & E prescribing remained static over the period of study. The audit process was also associated with a reduction in analgesic prescribing in general. The results of this study indicate that an educationally-based system for improving prescribing can change prescribing habits in the short term; these can be maintained in the longer term provided that the policy is continually monitored and reinforced by regular appraisal meetings with specialist clinicians and pharmacists. It is suggested that this educational approach can readily be adapted to the primary care setting, with general practitioners rather than specialists taking the leadership role. This would encourage the achievement of common prescribing strategies between hospitals and community that are not wholly financially led.