Improving the quality of insulin prescribing for people with diabetes being discharged from hospital

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.

Handwritten prescription practices in a public hospital in Uasin Gishu County, Kenya: a best practice implementation project

“…28,29 However, because of the cost of implementing an electronic prescription system, especially in resourcelimited settings, continuous medical education of health prescribers is an effective way to solve the problem of illegible prescriptions. 41,42 The improvement in compliance observed in the follow-up audit for some of the criteria is attributed to the health prescribers' sensitization to essential features of a handwritten prescription, dissemination of the audit report to the health prescribers during the regular continuous medical education sessions, and sharing of the report through the hospital communication group. We also developed a drug availability list that is updated weekly.…”

“…Such reminders have been documented as being effective in addressing medical errors resulting from handwritten prescriptions. 42 The presence of an active quality improvement committee composed of the health management team contributed to the improvement in compliance with the handwritten prescription best practices.…”

Lessons learned: using adverse incident reports to investigate the characteristics and causes of prescribing errors

“…This could involve continuous quality improvement, consisting of 'plan-do-studyact' cycles of iterative change, at a departmental/ ward level, as successfully trialled elsewhere. 9 Of note, electronic prescribing has been introduced more broadly across the NHS board since the data collection period. Evidence suggests that this may also reduce the frequency of medication errors, however local evaluation is required.…”

Discharge pharmacotherapy for Type 2 diabetic inpatients at two hospitals of different tiers in Zhejiang Province, China

“…There are little recommendations or any process for discharge transition [2], and even less about tailored discharge pharmacotherapy for T2DM [14]. Developing practical algorithms for therapeutic transition from hospitalization to home management is of paramount importance [40]. We hold that a cautious inference could be made from our analysis on the influences of discharge pharmacology (Tables 3 and 5) that a practical algorithm based on HbA1c to direct discharge pharmacology (especially in insulin initiation and adjustment) in inadequately controlled T2DM is feasible and incorporation of disease characteristics like duration and vascular conditions might provide extra optimization.…”