Article Text
Abstract
Medication errors involving insulin in hospital are common, and may be particularly problematic at the point of transfer of care. Our aim was to improve the safety of insulin prescribing on discharge from hospital using a continuous improvement methodology involving cycles of iterative change. A multidisciplinary project team formulated locally tailored insulin discharge prescribing guidance. After baseline data collection, three ‘plan-do-study-act’ cycles were undertaken over a 3-week period (September/October 2018) to introduce the guidelines and improve the quality of discharge prescriptions from one diabetes ward at the hospital. Discharge prescriptions involving insulin from the ward during Monday to Friday of each week were examined, and their adherence to the guidance measured. After the introduction of the guidelines in the form of a poster, and later a checklist, the adherence to guidelines rose from an average of 50% to 99%. Qualitative data suggested that although it took pharmacists slightly longer to clinically verify discharge prescriptions, the interventions resulted in a clear and helpful reminder to help improve discharge quality for the benefit of patient safety. This project highlights that small iterative changes made by a multidisciplinary project team can result in improvement of insulin discharge prescription quality. The sustainability and scale of the intervention may be improved by its integration into the electronic prescribing system so that all users may access and refer to the guidance when prescribing insulin for patients at the point of discharge.
- insulin
- electronic prescribing
- patient discharge
- diabetes mellitus
- medication errors
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Footnotes
Contributors AB and SK conceptualised the project under the academic supervision of JS and GQ. AB and IF designed and iterated the interventions with the help of the project team and ward staff. SK provided supervisory support throughout the project and helped to coordinate the project group. AB and IF undertook data collection, analysis and drafted the manuscript. JS and GQ provided methodological and editorial guidance.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval for the project was granted by the University of Bradford (Ref: EC25219) and was not required by STHFT.
Provenance and peer review Not commissioned; externally peer reviewed.