Setting

This audit was carried out across all acute psychiatric in-patient wards in a district general hospital. It has since been repeated in other local psychiatric units with acute admission wards.

Background

Patients admitted to psychiatric units are frequently prescribed medication during their admission. Individual National Health Service (NHS) organisations will have their own guidelines as to how the prescription charts are to be completed and these will be based on guidelines in the British National Formulary (BNF) (Joint Formulary Committee, 2009). Guidelines are usually printed on the front of in-patient prescription charts. An audit of in-patient prescription charts is often a popular audit for junior doctors to undertake, as it can be completed quickly. This audit has proved popular locally and has been subject to re-audit on a number of occasions.

Standards

Standards were obtained from the BNFand from the guidelines printed on the front of the local in-patient prescription charts. Of particular relevance were the following:

ᐅ Prescription charts should be written in ink, using capital letters.

ᐅ The patient's name, date of birth and hospital number should appear on the front of the chart.

ᐅ The allergy section should be completed (it is not satisfactory to leave this blank or to write ‘not known’).

ᐅ Prescriptions should be legible.

ᐅ Each prescription should be signed and dated by the prescribing doctor.

ᐅ Approved generic drug names should be used unless inappropriate (e.g. where different preparations do not have the same bioavailability).

ᐅ Administration times should be clearly marked.

ᐅ The dosage should be clearly marked for each prescription.

ᐅ When a drug is discontinued, the individual prescription should be clearly crossed through in ink, signed and dated.

ᐅ For ‘as required’ (p.r.n.) medication, the indication should be clearly recorded and a single administration route should be specified for each drug prescription box.

The target is that these standards are met for all in-patient prescription charts.

Method

Data collection

A data-collection sheet was drawn up to record adherence to the above standards for each prescription chart audited. The prescription charts for all in-patients on a given day were identified. Each prescription chart in turn was then examined to determine whether the above standards had been met.