Monitored dosage systems (or dose administration aids) are widely used but it is important to reduce their inappropriate use by ensuring they are only issued on a case-by-case basis to address specific practical problems of medicines adherence. It should be assumed that patients can manage their medicines unless indicated otherwise. NICE guidance (1) states monitored dosage systems should be considered as an option to improve adherence on a case-by-case basis, and only if there is a specific need to overcome practical problems. This should follow a discussion with the patient to explore possible reasons for nonadherence and the options available to improve adherence, if that is their wish.
• The inappropriate use of monitored dosage systems can make patients and carers less familiar with their medicines. Health literacy including awareness of medicines should be promoted.
• Transferring medicines to monitored dosage systems carries the risk of human error. The stability of many medicines cannot be guaranteed outside their original packaging.
• Patients who may benefit from monitored dosage systems include patients who have less ability to read or understand the instructions on standard medicines packaging, but who have the dexterity to use the devices and who wish to adhere to their medicines regimen.
• Pharmacists should check compliance issues and provide a monitored dosage system only if compliance cannot be addressed by other methods a...
Monitored dosage systems (or dose administration aids) are widely used but it is important to reduce their inappropriate use by ensuring they are only issued on a case-by-case basis to address specific practical problems of medicines adherence. It should be assumed that patients can manage their medicines unless indicated otherwise. NICE guidance (1) states monitored dosage systems should be considered as an option to improve adherence on a case-by-case basis, and only if there is a specific need to overcome practical problems. This should follow a discussion with the patient to explore possible reasons for nonadherence and the options available to improve adherence, if that is their wish.
• The inappropriate use of monitored dosage systems can make patients and carers less familiar with their medicines. Health literacy including awareness of medicines should be promoted.
• Transferring medicines to monitored dosage systems carries the risk of human error. The stability of many medicines cannot be guaranteed outside their original packaging.
• Patients who may benefit from monitored dosage systems include patients who have less ability to read or understand the instructions on standard medicines packaging, but who have the dexterity to use the devices and who wish to adhere to their medicines regimen.
• Pharmacists should check compliance issues and provide a monitored dosage system only if compliance cannot be addressed by other methods and the patient has the dexterity and health literacy to use the monitored dosage system.
• Patients may only be able to have part of their medication regimen supplied in a monitored dosage system with other medications provided in their original containers, leading to confusion and the risk of non adherence.
• Patients who use monitored dosage systems some of which are stored in the fridge and some out of the fridge may be at risk of non adherence if either is overlooked, forgotten etc
• Examples of problems which may affect compliance and solutions should be considered before a decision is made to supply a monitored dosage system (2) . The patient should be involved in any decisions and their preferences should be explored.
• The level of support available to the patient should be understood. Does the patient self administer? Is the patient supported by family and / or trained/registered staff?
• Patients using a monitored dosage system should be assessed regularly for appropriate and safe use.
(1)National Institute for Health and Clinical Excellence, 2009.Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. NICE Guideline CG76
(2) NHS Tayside, Compliance Needs Assessment Background Notes
The section in this paper which says pharmacists could prescribe controlled drugs from 2012 with the exception of schedule 1 and 2 CDs for drug misuse is misleading. Schedule 1 cannot be prescribed by anyone without out a licence to do so (this includes doctors) and schedule 1 contains substances of no medicinal use. Schedule 2 CDs can be prescribed by pharmacists for drug misuse, the only exception is diamorphine (and technically cocaine and dipipanone although these are not used). Diamorphine is prescribed as an injectable by prescribers on the Dept of Health approved list to do so and this list is restricted to medical doctors. Other schedule 2 drugs for addiction such as methadone and morphine (unlicensed) can be prescribed by pharmacist prescribers.
Wright and colleagues report on a single centre survey of inpatient
perceptions and experiences of the current discharge process, and identify
improvement opportunities in relation to waiting for medicines, and lack
of counselling by pharmacists.(1) Problems such as low awareness among
inpatients of pharmacy services, or pharmacists citing challenges to
achieving patient medication counselling have b...
Wright and colleagues report on a single centre survey of inpatient
perceptions and experiences of the current discharge process, and identify
improvement opportunities in relation to waiting for medicines, and lack
of counselling by pharmacists.(1) Problems such as low awareness among
inpatients of pharmacy services, or pharmacists citing challenges to
achieving patient medication counselling have been reported
internationally.(2,3)
In summer 2015 we undertook a similar small survey (building on our
previous work from 20124) at our 600 bedded teaching hospital. A Patient
Ambassador approached 33 patients (22 aged over 60 years) to ask questions
about their knowledge of their medicines. Thirty (90%) patients were
taking regular medicines prior to admission. Of these 30, 22 patients
recognised that their existing medicines had been changed whilst in
hospital, one did not know, and 7 claimed that there had been no changes.
Seventeen (77%) of the 22 patients reported that medication changes had
been explained to them, though in only 2 instances did the patient
acknowledge that the pharmacist undertook this counselling. Of the 26
patients commenced on new medicines during their stay only 6 (23%)
received information on side effects. Despite this, 18 of all 33
participants indicated that they received enough information about their
medication during their stay, though only 3 of these patients responded
that this information had been provided by the pharmacist.
Wright et al quite correctly reference the importance attached to the
National NHS Inpatient Survey which assesses patient experience at
hospitals across England, and results from the medicines related questions
section of this survey form part of the Hospital Pharmacy and Medicines
Optimisation project. They also argue for the development of a new model
of care for patient discharge. As an enhancement to discharge medicines
counselling provided by pharmacy, we are utilising a checklist for nursing
staff to follow when discharging patients which requires the nurse to
explain the medication and side effects. We have also very recently moved
from a faxing system to an electronic referral system (Pharmoutcomes) for
sending critical clinical information to a patient's regular community
pharmacy to enable the community pharmacist to offer on-going support and
advice on medication-related issue that may have arisen during the
admission.
Ensuring that all hospital processes around discharge and all
hospital staff involved with the discharge process are aligned with such a
new model of care for patient discharge may benefit from adopting the
Always Event approach.(5)
Yours sincerely
Mike Wilcock
Sally Miles
Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall
REFERENCES
1. Wright S, Charles W, Morecroft CW, Mullen R, Ewing AB. UK hospital
patient discharge: the patient perspective. Eur J Hosp Pharm
doi:10.1136/ejhpharm-2016-001134
2.King PK, Martin SJ, Betka EM. Patient awareness and expectations of
pharmacist services during hospital stay. J Pharm Pract 2016 Aug 31. pii:
0897190016665541
3. Chevalier BA, Watson BM, Barras MA, Cottrell WN. Hospital pharmacists'
perceptions of medication counseling: A focus group study. Res Social Adm
Pharm. 2016 Sep-Oct;12(5):756-71.
4. Wilcock M, Lawrence J. Patients' experience of the hospital pharmacy
team - still further work to be done! Pharmacy Management 2015;31(1):15-
20.
5. NHS England. Always event (cited 18 January 2017)
https://www.england.nhs.uk/ourwork/pe/always-events/
Comment 1: In case of stable patient, the priority of management for
extremity fracture in emergency department would be early reduction with
immobilization, pain relief is not the primary concern, on the other hand,
early pain relief might put the patient in a risk of delayed reduction
trial . As we know neurovascular compromise around fracture site is
critical for fracture management, and so, instead of decreasing time...
Comment 1: In case of stable patient, the priority of management for
extremity fracture in emergency department would be early reduction with
immobilization, pain relief is not the primary concern, on the other hand,
early pain relief might put the patient in a risk of delayed reduction
trial . As we know neurovascular compromise around fracture site is
critical for fracture management, and so, instead of decreasing time to
pain relief, I would rather suggest decreasing time to early reduction and
immobilization. That is more meaningful and practical for orthopedic
surgeon
Comment 2: If early pain relief is the main issue for concern, why
not IV or IM analgesic instead of oral administration, the former
treatment will relatively not influence the anesthesia procedure (due to
inadequate NPO time).
The population with intellectual disabilities are vulnerable in the prescribing and the deprescribing process.
In the population with intellectual disabilities compared to the general population, the multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs [1].
People with intellectual disabilities use multiple medications and may have been taking them for many years. Extreme care in required when de- prescribing many medications in this population group. The principles of good de-prescribing during medication review in the population with intellectual disabilities, based on the British Pharmacological Society’s Principles for Good Prescribing 2010, provide a template for quality de-prescribing in this vulnerable population group.
Principles of Good De-prescribing during Medication Review in the Population with Intellectual Disabilities and Behaviour Disorders. Based on the British Pharmacological Society’s Principles for Good Prescribing 2010
1. Be clear about the reasons for de-prescribing.
2. Take into account the patient with intellectual disabilities and behaviour disorders medication history before de-prescribing.
3. Take into account other factors that might alter the benefits and risks of de-prescribing treatment in the patient with intellectual disability and behaviour disorders.
4. Take into account the patient’s/carer’s/families/advocates ideas, concerns, and expec...
The population with intellectual disabilities are vulnerable in the prescribing and the deprescribing process.
In the population with intellectual disabilities compared to the general population, the multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs [1].
People with intellectual disabilities use multiple medications and may have been taking them for many years. Extreme care in required when de- prescribing many medications in this population group. The principles of good de-prescribing during medication review in the population with intellectual disabilities, based on the British Pharmacological Society’s Principles for Good Prescribing 2010, provide a template for quality de-prescribing in this vulnerable population group.
Principles of Good De-prescribing during Medication Review in the Population with Intellectual Disabilities and Behaviour Disorders. Based on the British Pharmacological Society’s Principles for Good Prescribing 2010
1. Be clear about the reasons for de-prescribing.
2. Take into account the patient with intellectual disabilities and behaviour disorders medication history before de-prescribing.
3. Take into account other factors that might alter the benefits and risks of de-prescribing treatment in the patient with intellectual disability and behaviour disorders.
4. Take into account the patient’s/carer’s/families/advocates ideas, concerns, and expectations.
5. Ensure all medicines are effective, safe, cost-effective in appropriate form individualised for the patient with intellectual disability, behaviour disorders and other conditions such as dysphagia, autism.
6. Adhere to national guidelines and local formularies where appropriate. Use caution where the population with intellectual disability have not been considered in the guideline development process.
7. Write unambiguous correct documentation detailing reason for de-prescribing.
8. Monitor the beneficial and adverse effects of de-prescribing medicines and any effects on behaviour.
9. Communicate and document all de-prescribing decisions and the reasons for them such as transferred to appropriate personnel such as GP, pharmacist, psychiatrist, epileptologist, carer and patient.
10. De - prescribe within the limitations of your knowledge, skills and experience of the population with intellectual disabilities and behaviour disorders.
1. Cooper S-A, McLean G, Guthrie B, et al. Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis. BMC Family Practice. 2015;16:110. doi:10.1186/s12875-015-0329-3.
Reading the editorial – “Value or cost: looking for the wider perspective”,the one thing that struck us the most was,when pharmacists determine value,one of the most important variables that they take into account is the monetary cost of the intervention,say antibiotics.This raised several questions in our minds.What if the antibiotics on the hospital formulary were priced at a point that their use in certain situations seemed unjustified to pharmacists,but would seem perfectly justified at lower price points?What if generics,available at a fraction of the price of the branded variety,were used in place of the brands?It seems to us that they would most certainly impact the way that “value” is calculated for that particular scenario.What if the pharmacist knew a perfectly good enough generic,but hospital policy allowed procurement,and hence prescribing of,only a more expensive brand?
When hospital pharmacists try to assess the value of a new health technology,we feel that they would be well served if they took a long,hard look at the evidence.Sometimes claims might not be very genuine.And this could place heavy costs on the patients.A very contemporary example would be the pricing of cardiac stents. Cardiac stents are sold at a 300 to 400 percent mark up to Indian patients.A stent that costs Rs.20,000(Euro 284) if bought from a vendor would miraculously cost Rs.160,000(Euro 2273)at the hospital pharmacy,all other charges being separate.1The patient is not given the o...
Reading the editorial – “Value or cost: looking for the wider perspective”,the one thing that struck us the most was,when pharmacists determine value,one of the most important variables that they take into account is the monetary cost of the intervention,say antibiotics.This raised several questions in our minds.What if the antibiotics on the hospital formulary were priced at a point that their use in certain situations seemed unjustified to pharmacists,but would seem perfectly justified at lower price points?What if generics,available at a fraction of the price of the branded variety,were used in place of the brands?It seems to us that they would most certainly impact the way that “value” is calculated for that particular scenario.What if the pharmacist knew a perfectly good enough generic,but hospital policy allowed procurement,and hence prescribing of,only a more expensive brand?
When hospital pharmacists try to assess the value of a new health technology,we feel that they would be well served if they took a long,hard look at the evidence.Sometimes claims might not be very genuine.And this could place heavy costs on the patients.A very contemporary example would be the pricing of cardiac stents. Cardiac stents are sold at a 300 to 400 percent mark up to Indian patients.A stent that costs Rs.20,000(Euro 284) if bought from a vendor would miraculously cost Rs.160,000(Euro 2273)at the hospital pharmacy,all other charges being separate.1The patient is not given the option of purchasing the stent from anywhere but the pharmacy of the hospital conducting the procedure.The number of angioplasties performed in India is 420,000 every year1.Estimates say 80% of these are in private hospitals1..No comprehensive data exists on stent pricing by hospitals,but assuming an average “excess” profit of Rs.50,000(Euro 710) per stent for the estimated 336,000 angioplasties carried out in private hospitals,which seems reasonable in the given pricing landscape1,the potential for savings works out to 1,680 crore rupees(Euro 238 million) a year.And this is not the end of the story.Drug eluting and bio-absorbable stents are priced significantly higher than the bare metal stents,with companies claiming superiority of the drug eluting and bioabsorbable stents,but not being able to produce evidence of it.1The government of India has now capped the price of the metal stents at under 8,000 rupees(Euro 114) and the drug eluting and bioabsorbable stents at under 30,000 rupees(Euro 426).
In this case,government intervention in pricing seems to us to have made the greatest impact in delivering “value”.Similar government interventions in the pricing of antibiotics,anti HIV drugs and anti-cancer drugs could help pharmacists make more patient-centric decisions keeping in mind the value that patients are looking for.
Vulnerable populations are vulnerable because they are susceptible to
harm in health care environments. It is important that the healthcare
issues specific to the population with learning/intellectual disabilities
are considered when prescribing and deprescribing.
Deprescribing tools must be validated in the population with
learning/intellectual disabilities to ensure safety and quality care.
People with learn...
Vulnerable populations are vulnerable because they are susceptible to
harm in health care environments. It is important that the healthcare
issues specific to the population with learning/intellectual disabilities
are considered when prescribing and deprescribing.
Deprescribing tools must be validated in the population with
learning/intellectual disabilities to ensure safety and quality care.
People with learning/intellectual disabilities and behaviour disorders
provide particular challenges.
In the population with learning/intellectual disabilities compared
to the general population, the multi-morbidity burden is greater, occurs
at much earlier age, and the profile of health conditions differs [1].
People with learning/intellectual disabilities use multiple
medications and may have been taking them for many years. Extreme care in
required when de- prescribing many medications in this population group.
The principles of good de-prescribing during medication review in the
population with learning/intellectual disabilities, based on the British
Pharmacological Society's Principles for Good Prescribing 2010, provide a
template for quality de-prescribing in this population group.
Principles of Good De-prescribing during Medication Review in the
Population with Learning/Intellectual Disabilities (and Behaviour
Disorders). Based on the British Pharmacological Society's Principles for
Good Prescribing 2010
1. Be clear about the reasons for de-prescribing.
2. Take into account the patient with learning/intellectual disabilities
and behaviour disorders medication history before de-prescribing.
3. Take into account other factors that might alter the benefits and risks
of de-prescribing treatment in the patient with learning/intellectual
disability and behaviour disorders.
4. Take into account the patient's/carer's/families/advocates ideas,
concerns, and expectations.
5. Ensure all medicines are effective, safe, cost-effective in appropriate
form individualised for the patient with learning/intellectual disability,
behaviour disorders and other conditions such as dysphagia, autism.
6. Adhere to national guidelines and local formularies where appropriate.
Use caution where the population with learning/intellectual disability
have not been considered in the guideline development process.
7. Write unambiguous correct documentation detailing reason for de-
prescribing.
8. Monitor the beneficial and adverse effects of de-prescribing medicines
and any effects on behaviour.
9. Communicate and document all de-prescribing decisions and the reasons
for them such as transferred to appropriate personnel such as GP,
pharmacist, psychiatrist, epileptologist, carer and patient.
10. De - prescribe within the limitations of your knowledge, skills and
experience of the population with learning/intellectual disabilities and
behaviour disorders.
1. Cooper S-A, McLean G, Guthrie B, et al. Multiple physical and
mental health comorbidity in adults with intellectual disabilities:
population-based cross-sectional analysis. BMC Family Practice.
2015;16:110. doi:10.1186/s12875-015-0329-3.
Discharge summaries are an important connection between care in
hospital and primary care, and effective transfer of information is vital
for patient safety and continuity of care. Having spent my foundation
year one in hospital and now working in a general practice, I have been
able to see discharge summaries from both sides. Discharge summaries
contribute significantly to the work load of junior doctors and often
re...
Discharge summaries are an important connection between care in
hospital and primary care, and effective transfer of information is vital
for patient safety and continuity of care. Having spent my foundation
year one in hospital and now working in a general practice, I have been
able to see discharge summaries from both sides. Discharge summaries
contribute significantly to the work load of junior doctors and often
require long periods spent in front of a computer away from patients. The
quality of these summaries often varies between doctors but also depending
upon how much time the author can set aside for writing the summaries.
Any proformas or teaching to help juniors at this important task is
welcome.
It is unfortunate that the teaching interventions here did not show
improved discharge summaries and I wonder how the foundation year one
doctors would reflect on this teaching later in the year? It is
interesting that the foundation year two doctors seemed more reluctant to
consider that they could improve their discharge summary writing, so
perhaps establishing attitudes earlier in a trainee's career is an
important step. Maybe writing discharge summaries is a skill which could
be introduced to final year medical students? I look forward to reading
about future developments with this project.
As a result of this quality improvement project we have changed the
adult fluid prescription used within the Trust. We have redesigned the
prescription section to have a clearer space to document patient related
cautions, such as heart failure; and included a printed prompt for
'Indication' on each prescriptions line.
Well done folks!
We do not have a formalized A4 type of paper to fill up prior to the procedure, but we carry out most of these checks without ticking boxes. We have a pathway, which includes almost all of these and is normally checked by the Endoscopy nurse and a cancer specialist nurse. Only an independent bronchoscopist (not the trainee) is allowed to check the safety prior to add the patient in the list for the procedure.
I...
Well done folks!
We do not have a formalized A4 type of paper to fill up prior to the procedure, but we carry out most of these checks without ticking boxes. We have a pathway, which includes almost all of these and is normally checked by the Endoscopy nurse and a cancer specialist nurse. Only an independent bronchoscopist (not the trainee) is allowed to check the safety prior to add the patient in the list for the procedure.
I highly respect and appreciate your hard work to formalize this for the safety of the patient.
I would suggest you to check the patients ECG prior to the procedure (most them are middle aged and elderly population). I had been doing this for almost 15 years and unfortunately had encountered various ECG abnormalities which led to postponed the procedures. These were Complete and second degree heart blocks, unexplained bradycardia, various tacchyarrythmias and ischemic changes. Many of them were symptomatic for it's isolated reason, which could have easily been missed, if the ECG were not performed, due to their underlying illness mainly malignancy. If not wrong, I might have stopped some problem.
I thought that this would be helpful.
Once again, well done everybody.
Monitored dosage systems (or dose administration aids) are widely used but it is important to reduce their inappropriate use by ensuring they are only issued on a case-by-case basis to address specific practical problems of medicines adherence. It should be assumed that patients can manage their medicines unless indicated otherwise. NICE guidance (1) states monitored dosage systems should be considered as an option to improve adherence on a case-by-case basis, and only if there is a specific need to overcome practical problems. This should follow a discussion with the patient to explore possible reasons for nonadherence and the options available to improve adherence, if that is their wish.
Show More• The inappropriate use of monitored dosage systems can make patients and carers less familiar with their medicines. Health literacy including awareness of medicines should be promoted.
• Transferring medicines to monitored dosage systems carries the risk of human error. The stability of many medicines cannot be guaranteed outside their original packaging.
• Patients who may benefit from monitored dosage systems include patients who have less ability to read or understand the instructions on standard medicines packaging, but who have the dexterity to use the devices and who wish to adhere to their medicines regimen.
• Pharmacists should check compliance issues and provide a monitored dosage system only if compliance cannot be addressed by other methods a...
The section in this paper which says pharmacists could prescribe controlled drugs from 2012 with the exception of schedule 1 and 2 CDs for drug misuse is misleading. Schedule 1 cannot be prescribed by anyone without out a licence to do so (this includes doctors) and schedule 1 contains substances of no medicinal use. Schedule 2 CDs can be prescribed by pharmacists for drug misuse, the only exception is diamorphine (and technically cocaine and dipipanone although these are not used). Diamorphine is prescribed as an injectable by prescribers on the Dept of Health approved list to do so and this list is restricted to medical doctors. Other schedule 2 drugs for addiction such as methadone and morphine (unlicensed) can be prescribed by pharmacist prescribers.
Dear Editor
Wright and colleagues report on a single centre survey of inpatient perceptions and experiences of the current discharge process, and identify improvement opportunities in relation to waiting for medicines, and lack of counselling by pharmacists.(1) Problems such as low awareness among inpatients of pharmacy services, or pharmacists citing challenges to achieving patient medication counselling have b...
Comment 1: In case of stable patient, the priority of management for extremity fracture in emergency department would be early reduction with immobilization, pain relief is not the primary concern, on the other hand, early pain relief might put the patient in a risk of delayed reduction trial . As we know neurovascular compromise around fracture site is critical for fracture management, and so, instead of decreasing time...
The population with intellectual disabilities are vulnerable in the prescribing and the deprescribing process.
In the population with intellectual disabilities compared to the general population, the multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs [1].
People with intellectual disabilities use multiple medications and may have been taking them for many years. Extreme care in required when de- prescribing many medications in this population group. The principles of good de-prescribing during medication review in the population with intellectual disabilities, based on the British Pharmacological Society’s Principles for Good Prescribing 2010, provide a template for quality de-prescribing in this vulnerable population group.
Principles of Good De-prescribing during Medication Review in the Population with Intellectual Disabilities and Behaviour Disorders. Based on the British Pharmacological Society’s Principles for Good Prescribing 2010
Show More1. Be clear about the reasons for de-prescribing.
2. Take into account the patient with intellectual disabilities and behaviour disorders medication history before de-prescribing.
3. Take into account other factors that might alter the benefits and risks of de-prescribing treatment in the patient with intellectual disability and behaviour disorders.
4. Take into account the patient’s/carer’s/families/advocates ideas, concerns, and expec...
Reading the editorial – “Value or cost: looking for the wider perspective”,the one thing that struck us the most was,when pharmacists determine value,one of the most important variables that they take into account is the monetary cost of the intervention,say antibiotics.This raised several questions in our minds.What if the antibiotics on the hospital formulary were priced at a point that their use in certain situations seemed unjustified to pharmacists,but would seem perfectly justified at lower price points?What if generics,available at a fraction of the price of the branded variety,were used in place of the brands?It seems to us that they would most certainly impact the way that “value” is calculated for that particular scenario.What if the pharmacist knew a perfectly good enough generic,but hospital policy allowed procurement,and hence prescribing of,only a more expensive brand?
Show MoreWhen hospital pharmacists try to assess the value of a new health technology,we feel that they would be well served if they took a long,hard look at the evidence.Sometimes claims might not be very genuine.And this could place heavy costs on the patients.A very contemporary example would be the pricing of cardiac stents. Cardiac stents are sold at a 300 to 400 percent mark up to Indian patients.A stent that costs Rs.20,000(Euro 284) if bought from a vendor would miraculously cost Rs.160,000(Euro 2273)at the hospital pharmacy,all other charges being separate.1The patient is not given the o...
Vulnerable populations are vulnerable because they are susceptible to harm in health care environments. It is important that the healthcare issues specific to the population with learning/intellectual disabilities are considered when prescribing and deprescribing.
Deprescribing tools must be validated in the population with learning/intellectual disabilities to ensure safety and quality care. People with learn...
Discharge summaries are an important connection between care in hospital and primary care, and effective transfer of information is vital for patient safety and continuity of care. Having spent my foundation year one in hospital and now working in a general practice, I have been able to see discharge summaries from both sides. Discharge summaries contribute significantly to the work load of junior doctors and often re...
As a result of this quality improvement project we have changed the adult fluid prescription used within the Trust. We have redesigned the prescription section to have a clearer space to document patient related cautions, such as heart failure; and included a printed prompt for 'Indication' on each prescriptions line.
Conflict of Interest:
None declared
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