SPARS Research Projects

Review of evidence to unify prescribing documentation

Review of evidence to unify prescribing documentation

A range of secondary evidence resources was searched electronically following the Healthcare Improvement Scotland knowledge management standard checklist, including SIGN, NICE, GIN, CDSR, HTA, DARE, The Health Foundation, Joanna Briggs Institute, NHS Institute for Innovation and Improvement, Institute for Healthcare Improvement, NHS Evidence Innovation and Improvement, and various government and national policy sources. Additional sources included AHRQ, NHS Wales publications, Australian Department of Health and Ageing, New Zealand Ministry of Health, and Health Canada. NHS Evidence Quality and Productivity, and the internet were searched to identify grey literature. The electronic databases MEDLINE, EMBASE and CINAHL were searched from inception to identify relevant primary research. The main search terms were ‘single prescription administration chart’, ‘standard medication chart’, ‘standard drug chart’, ‘standard medicines administration record’, ‘National Patient Medication Chart’ and ‘kardex’.

The search results were initially sifted for relevance to single prescription and administration charts. Thirty articles were retained for further assessment and selection of those that provided evidence of benefit or harm. Six articles were obtained in full and 5 were subsequently included. One other published article obtained from the author, and an unpublished report identified from the reference list in one of the included articles were also included.

Drug chart variability study

Recent evidence has suggested that the implementation of a national inpatient prescription record can reduce prescribing errors and therefore the Single Prescription and Administration Record for Scotland (SPARS) committee has been formed to consider the implementation of a unified prescription chart in Scotland.

Objective: To compare the design characteristics and content of existing hospital prescription records across Scotland’s 14 health boards and quantify the variance in current documentation. We designed a new prescription record assessment tool and used it to objectively assess 20 hospital prescription records against a series of detailed criteria and parameters. Prescription records were largely similar in general layout and content with heterogeneity arising in the details required for the prescription of a medication and patient information. There were major variations in the ID codes for non-administration and the manner in which drug allergies were recorded. This study indicates that although the major content of prescription records in Scottish hospitals is similar, there are areas of significant variation. These would have to be resolved and agreed between stakeholders if a unified chart is to be implemented. These variations will continue to pose a challenge for prescribers who move between hospitals and those who train them.

Impact of chart design on prescribing performance

Initiatives to standardise hospital paper-based prescription charts are underway in various countries in an effort to reduce prescribing errors. The aim of this study was to investigate the extent to which prescribing error rates are influenced by prescription chart design and familiarity. Foundation Year one doctors working in five Scottish NHS Boards participated in study sessions during which they were asked to prescribe lists of medications for five fictional patients using a different design of paper prescription chart for each patient. Each doctor was timed completing each set of prescriptions, and each chart was subsequently assessed against a pre-defined list of possible errors. A mixed modelling approach using three levels of variables (design of and familiarity with a chart, prescribing speed and individual prescriber) was employed. A total of 72 FY1s participated in ten data collection sessions. The prescription charts from two NHS boards charts produced significantly higher error rates than the other three charts. Participants who took longer to complete their prescriptions made significantly fewer errors, but familiarity with a chart did not predict error rate. Differences in prescription chart were associated with significant variations in the rates of prescribing error, but familiarity with a specific chart design was not protective against error.  The time taken to complete a prescribing task was inversely related to the rate of error emphasising the importance of attention to detail and workload as factors in error causation.  Further work is required to identify the characteristics of prescription charts that are protective against errors.

For more information, please see:
British Medical Journal Quality & Safety: The contribution of prescription chart design and familiarity to prescribing error: a prospective, randomised, cross-over study