Search

Background Patients with unexplained falls, syncope and dizziness frequently present acutely. There are multiple IT systems in operation across the acute hospital network with varying functionality relating to activity capture. MAXIMS is an electronic healthcare record used to capture attendances in our ED. Within our department a digital patient management system Electronic Patient Management System (EPMS) records clinical information from admission through to discharge. The Hospital Inpatient Enquiry System (HIPE) is the principal national source of discharge information from acute hospitals. We aimed to look at this cohort of patients and compare the clinical data available on each of these information sources used in a Model 4 teaching hospital. Methods MAXIMS database was interrogated to examine patients who presented to the ED with the search terms "falls", "syncope" and "dizziness". We conducted a review of all patients who met our search terms over two non-consecutive weeks in 2018. For the same period EPMS was interrogated and HIPE data were requested and analysed. Results MAXIMS, EPMS and HIPE records over the two-week period captured 190, 104 and 24 patients respectively. Mean age was 62, 75 and 72 years. Of 190 records on MAXIMS, 107 (56%) were not coded on HIPE following discharge. Of these 107 patients, 93 (87%) did not require a hospital admission and 14 (13%) patients self-discharged. Conclusion Current available digital systems provide inconsistent information relating to patients presenting acutely with falls, dizziness and syncope. How these conditions are captured electronically can vary between systems due to which parameters are recorded. HIPE stats were lower than Maxims/EPMS which may reflect the fact that HIPE only captures discharge diagnosis as opposed to presenting symptoms. In order to get a clearer picture of these conditions, and for planning purposes, an approach amalgamating the data from all systems into one electronic source would be required. [ABSTRACT FROM AUTHOR]

Background Generic Prescribing is an essential component of prescribing, however it is often overlooked. Use of brand names can led to poor recognition of the correct medications. It can also led to medication error. It is part of the policy of our hospital group that generic prescribing is used at all times. We performed a similar audit in 2018 and 79% of drug kardexes had brand names used. Prescribing education is an integral part of NCHD teaching. We wished to re-audit to determine rates of generic prescribing now. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. Each drug was reviewed and if any prescription had brand names, the entire kardex was deemed non-compliant. Results 285 Drug kardexes were assessed across 14 separate wards. 41% were on surgical wards, 59% were on medical wards. 31 (11%) of kardexes had complete generic prescribing. Only 3 kardexes on the surgical ward had complete generic prescribing. Conclusion The low rates of generic prescribing remain an issue in our university teaching hospital. A similar audit was performed in 2018 with average rates of 20% of generic prescribing. This has decreased in the last year. The failure to generic prescribe puts patients at risk of medication error and also increases cost to the HSE. Education on prescribing is part of the NCHD induction, however, 9 months on there continues to be issues with compliance with generic prescribing. Education alone is not enough to improve current practice. The use of e prescribing offers the potential to alleviate this problem. [ABSTRACT FROM AUTHOR]

Background Illegible prescribing can lead to medication error and adverse drug reactions. The HSE Standards and Recommended Practices for Healthcare Records Management and the Practice Standards and Guidelines for Nurses for Prescriptive Authority have highlighted criteria which should be adhered to in relation to prescribing. We set out to audit compliance with these standards in relation to legibility of prescriptions in an Irish University Teaching Hospital. Methods Over a 48 hour period, drug kardexes were reviewed on 14 separate in-patient wards. Legibility was judged by a single assessor on each ward. A drug kardex was deemed legible if all of the following criteria were met: The writing was clear and un-joined, in upper or lower case text. Only approved abbreviations were used. Doses were clear, with zero preceding decimal points, and appropriate measurement units used. In cases where weight dependent medications were prescribed, the patient's weight was clearly documented. The chi squared test was used to determine the significance of the difference in proportions for categorical variables. Results 285 drug kardexes were reviewed over the 48 hour period. 41% were on surgical wards, 59% were on medical wards. The median patient age was 70 (IQR:55-78), and 56% were male. 48% of drug kardexes were deemed legible. A higher proportion were deemed legible on medical wards compared to surgical wards (68% vs 19% p<0.05). Upper case was used in 13% of kardexes, with similar proportions on medical and surgical wards. Conclusion Poor legibility of drug kardexes may increase risk of medication errors and adverse drug reactions. We plan to commence targeted prescribing education sessions to highlight the current deficiencies and improve current practice. Changes to kardex layout may also aid legibility. Long term planning for electronic prescribing would also help resolve issues in this area. [ABSTRACT FROM AUTHOR]