Background Prescribing errors are common and a known cause of adverse patient outcomes. Junior doctors are responsible for the majority of prescribing, and may benefit from educational interventions. Aim To assess the effect of (1) targeted pharmacist‐led feedback and education, and (2) an e‐learning prescribing module, on prescription writing error rates by junior doctors in the inpatient medical setting. Methods We undertook a cluster randomised trial in 2014 involving 16 prescribers in four general medical units of an Australian tertiary hospital. One unit was randomised to prescribing feedback and targeted education by a clinical pharmacist; another unit was randomised to an e‐learning intervention on safe prescribing; and two units were randomised to no intervention. Data were collected via daily audit of paper medication charts. A prescription writing error was deemed to have occurred if patient or prescriber details were incomplete, or if a medication order was illegible, incomplete or incorrect. Statistical analysis was by Chi‐squared comparison of each unit's error rate pre‐intervention to post‐intervention. Results Prescription writing errors were significantly reduced in the pharmacist education group, from 0.58 errors/total orders pre‐intervention to 0.37 errors/total orders post‐intervention (p < 0.001). Conversely, an increase in the error rate of the control group was observed from 0.49 to 0.59 errors/total orders (p < 0.001), and to a lesser extent in the e‐learning group from 0.58 to 0.63 errors/total orders (p = 0.025). Conclusions Regular and targeted pharmacist feedback and education is effective at reducing prescription writing errors, while the effect of e‐learning tools remains unclear.

Funding Acknowledgements Type of funding sources: None. Background The risk of medication-induced QT prolongation can be mitigated by reviewing electrocardiograms (ECG) in a hospital inpatient setting. Currently, within the Electronic Medical Record (EMR), decision support tools do not exist to conduct ECG monitoring when prescribing multiple QT prolonging medications. This retrospective review of prescribing data from 2021 looked to assess if we are appropriately ordering ECGs. The results could potentially guide developing decision support tools within the EMR to influence the prescribing of QT-prolonging medications and reduce the risk of QT-prolongation in hospitalised patients. Purpose To ascertain the prevalence of baseline and follow-up ECGs when three or more known QT prolonging medications were concurrently administered. Methods QT prolonging medications were defined using Crediblemeds [1], an online resource aimed to support the safe prescribing of QT prolonging medications. Known QT prolonging medications were defined as medications which prolong the QT interval and are associated with Torsades de Pointes. A retrospective review of inpatient prescribing in 2021 was conducted by extracting data from the EMR. Patients who received three or more of these medications on the same calendar day were included. Information reported included patient demographics, details of QT prolonging medication and whether ECGs were performed. Certain intra-operative medications were excluded from review due to the short patient exposure time to the medication. ECGs were reviewed independently by two pharmacists and the QTc interval was calculated using the Bazett formula. Results A total of 70 patients received three or more QT prolonging medications. In total, 30 (43%) patients had a baseline ECG performed within seven days of medication commencement and 6 (9%) patients received both a baseline and follow-up ECG within 24 hours of medication administration. One patient had a prolonged QTc (&gt;500msec) on their baseline ECG. Baseline ECGs were not performed in 29 (41%) of patients whereas Eleven patients (16%) had an ECG on record, but it was older than seven days prior to medication administration. Three patients without a baseline ECG had a follow-up ECG within 24 hours after medication administration. Overall, 28 different medications were identified with Ondansetron, Ciprofloxacin and Escitalopram appearing most commonly. Conclusions This audit indicates that clinicians are not consistently ordering ECGs at baseline or utilising follow up ECGs when prescribing concurrent QT prolonging medications which may increase the risk of preventable patient harm. Though QT prolongation was not detected on follow-up ECGs, this may be impacted by the low prevalence of follow-up ECGs. The utilisation of decision support tools within the EMR may improve ECG monitoring in patients at risk of QT prolongation.