Checklists for safe prescribing in oral medicine clinics.

Abstract

Introduction Prescribing checklists are a means of managing risk related to systemic medications in oral medicine practice.Methods Checklists for workup and monitoring for azathioprine, mycophenolate mofetil (MMF) and dapsone were introduced to an oral medicine clinic. Compliance with the checklists was audited at six and 12-24 months post introduction, and compared to previous clinical practice.Results Azathioprine: compliance with viral serology screening improved from <10% to over 80% at 6 months post checklist introduction, and was 100% at 12 months. Documentation of counselling improved from 48% to 85% at six months, and was 100% at 12 months. Compliance with tuberculosis risk assessment improved from 5% to 50% at six months but declined to 4% at 12 months. Compliance with monitoring blood tests improved slightly. MMF: compliance with viral serology screening increased from nil to 100% at six months. Documented evidence of counselling increased from 20% to 100%. Monitoring blood test compliance for the first six weeks of therapy improved. Dapsone: documentation of patient counselling improved from 25% pre-checklist, to 50% at six months and 60% at 24 months. Monitoring blood test compliance improved at six months but had decreased by 24 months.Discussion and conclusion Clinical checklists led to a modest improvement in prescribing safety in our clinics. The usefulness of checklists depends on cultural changes and clinician engagement. Electronic medication safety programs may be a useful future strategy.