P57 Ensuring safe and efficient prescribing: an audit of external prescription requests from the National Centre of Paediatric Rheumatology, Ireland

Abstract

Abstract Background Medication prescribing in paediatric rheumatology is closely monitored, particularly as a large number of medications used are either DMARDs or biologic therapy. Within our centre, we aim to give prescriptions when patients are attending outpatient clinics however due to long waiting lists, some patients require prescriptions before their clinic appointment. Currently, this is arranged by parents phoning in to our secretaries, however they often do not have the medication dose or route and this can delay efficient prescribing. We have also found that as most patients have their blood monitoring done in a primary care setting, we do not have access to their results. The aim of our audit was to formally assess outpatient prescribing in our centre, with a view to streamlining the process. Methods Data was collected over a one month period between 05/03/19 and the 05/04/19. Each prescription request was received by our CNS or secretary and passed to the NCHDs. The date and medication required was documented, along with chart availability, last clinic date, last bloods taken, whether the parents gave the dose and if a prescription was ultimately written. All data was analysed using Microsoft Excel. Results In total 36 prescriptions were requested. The majority of prescriptions (28) were routine prescriptions, with an additional 6 for ‘emergency’ prescriptions (e.g. diclofenac, ondansetron, NSAIDs and prednisolone) and 2 prescriptions were for a change in medication. Overall, 17 requests were for biologic agents, 7 for methotrexate and 5 for both biologic and methotrexate. Charts were available for 27 patients. Of those not available, 5 parents had given doses with their requests. If doses and charts were not available the dose from the last clinic letter on the system was used. Only in 10 cases out of 36, did parents leave a dose for medication with their prescription request. In total, 21 patients had recent blood tests recorded on our hospital database in the last 3 months and 27 had had clinic appointments in the preceding 6 months, with 13 of these occurring in the preceding 3 months. Conclusion This study highlights the large volume of external prescription requests received, as well as the potential for error in prescribing. We are currently planning on introducing a form that parents will be required to complete with all prescription requests, detailing dose and route of medication along with the results of their most recent blood tests. We hope that this will both streamline the process and allow for safer prescribing and plan to re-audit 3 months after its implementation. Conflicts of Interest The authors declare no conflicts of interest.