The Effect of an Education Session on Medication Documentation Quality in a Model 2 Irish Hospital: a Closed Loop Audit

Abstract Background Medication errors are associated with significant morbidity, mortality and cost. The three key priority areas identified by the WHO Medication Without Harm initiative are high-risk situations (e.g. older patients), polypharmacy (five or more chronic medications) and transitions of care; all of which are pertinent to our setting. We aimed to examine the quality of documentation of prescribing and transcribing in an Irish model 2 hospital. Methods A retrospective chart review of 100 hospital inpatients was conducted (50 at initial audit stage, and a further 50 during reaudit) in 2023. An adapted version of the MediDocQ patient safety instrument was used for data extraction. A prescribing education session was held with NCHDs and reaudit was performed 10 weeks later. Results The average age within our patient cohort was 76. Rates of polypharmacy and hyperpolypharmacy (10 or more chronic medications) were 76% and 46% respectively. Prescribing completeness for as required medications (individual & maximum dose, indication) and discontinuations (dated, initialed, reason indicated) were 35% and 21% initially; with a respective decline to 33% and increase to 31%. Overall completeness of both prescribing of regular medications and transcribing was high for both groups with a slight improvement post-intervention. Allergy status documentation improved from 90% to 100%, while documentation of nature of reaction declined from 43% to 31%. Conclusion Our findings demonstrated neither a convincing nor consistent improvement in prescribing or transcribing quality following an education session with NCHDs. This is consistent with a recent Cochrane review (1). The best evidence for addressing medication errors appears to be for computerised physician order entry systems, which minimise room for human error. Reference 1. Ciapponi, A, Nievas, SEF, Seijo, M. et al. Reducing medication errors for adults in hospital settings. Cochrane Database of Systematic Reviews [Internet]. 2021;2021: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8614640/.