safer prescribing in adhd · safer prescribing in adhd - aligning documentation with nice...

Safer Prescribing in ADHD - Aligning Documentation with NICE Guidelines - Wright S Paediatric ST5 Poole Hospital NHS Founda9on Trust 1. A=en9on Deficit Hyperac9vity Disorder: Diagnosis & Management (CG 72) 2. ADHD Audit (2014), Poole NHS Founda9on Trust References 48 cases were iden9fied with 10 excluded as unable to obtain notes. Demographics: Male 87%; Female 13%. Following an inXdepth analysis of medical notes and clinic le=ers, the results were not dissimilar to the 2014 audit findings. Whilst highligh9ng many posi9ves in prescribing prac9ce (Fig. 1), other standards of preXprescrip9on documenta9on remained poor (Fig. 2X5). In addi9on, the prescribing proforma was not in regular use with only 8% of case notes containing a copy. Introduc9on NICE provide evidenceXbased guidance for the prescrip9on of medica9on used to treat schoolX aged children diagnosed with severe ADHD. An audit undertaken locally in 2014 evidenced that prescribing standards were not consistently recorded in the pa9ent’s notes. As part of changes to prac9ce, an ADHD Prescribing Proforma was introduced throughout the department to improve the quality and clarity of prescribing documenta9on and thus enhance pa9ent safety. Method Hospital coding was used to iden9fy children commencing ADHD medica9on in 2016 at Poole Hospital. Retrospec9ve analysis of medical notes was carried out to review documenta9on of the medica9on prescrip9ons. NICE CG72 was used as the gold standard with a 9me period of ‘within 3 months’ used for the observa9ons taken prior to medica9on commencing. Results Fig 1: POSITIVE PRACTICE 100% pa9ents received first line medica9on 100% pa9ents were schoolXaged 97% prescrip9ons ini9ated by professionals with exper9se in ADHD 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% BP Heart Rate Height Weight Percentage of Cases Fig. 2: BASELINE OBSERVATIONS Recorded Not recorded 0 10 20 30 40 50 60 70 80 90 100 Part of Comprehensive Treatment Plan Moderate/Severe ADHD Considera9on of coX morbid condi9ons Percentage of Cases Fig. 3: MANAGEMENT OF ADHD Yes No Not Recorded 0 20 40 60 80 100 Mental Health / Social Assessment Substance Misuse / Drug Diversion Percentage of Cases Fig. 5: PREIPRESCRIPTION ASSESSMENTS Documented Not Documented 0 20 40 60 80 100 Assessment of Cardiac PMH Asssessment of Cardiac FHx ECG ECG if Posi9ve FHx Iden9fied Percentage of Cases Fig. 4: CARDIAC ASSESSMENT Documented Not Documented Similar to 2014 audit data, documenta9on in ADHD prescribing remained substandard and did not meet the gold standards of NICE CG72. The study was however limited by an awareness that wri=en documenta9on may not fully reflect true clinical prac9ce and that the interpreta9on of qualita9ve data is, to an extent, subjec9ve. Through presen9ng the data & talking to clinicians, it became apparent that some were not aware of the prescribing proforma or did not have access to it. Others were resistant to using something that was felt to be 9meXconsuming or dictatorial to their prac9ce ager years of experience. Subsequently, an abbreviated ‘prescribing checklist’ has been created in conjunc9on with prescribers (Fig. 6), focussing on the weaker areas of documenta9on. It aims to being more user friendly whilst s9ll promp9ng the prescriber to meet prescribing gold standards and improve prescrip9on safety. Conclusion & Changes to Prac9ce Fig. 6: ADHD PREXPRESCRIPTION ASSESSMENT FORM

Upload: others

Post on 26-Aug-2020

5 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

Safer Prescribing in ADHD - Aligning Documentation with NICE Guidelines -

Wright'S'Paediatric'ST5'

Poole'Hospital'NHS'Founda9on'Trust'

1.  A=en9on'Deficit'Hyperac9vity'Disorder:'Diagnosis'&'Management'(CG'72) '2.''''ADHD'Audit'(2014),'Poole'NHS'Founda9on'Trust''

References''''

48'cases'were'iden9fied'with'10'excluded'as'unable'to'obtain'notes.'Demographics:'Male'87%;'Female'13%.''

Following' an' inXdepth' analysis' of' medical' notes' and' clinic'le=ers,' the' results' were' not' dissimilar' to' the' 2014' audit'findings.' Whilst' highligh9ng' many' posi9ves' in' prescribing'prac9ce' (Fig.' 1),' other' standards' of' preXprescrip9on'documenta9on' remained' poor' (Fig.' 2X5).' In' addi9on,' the'prescribing'proforma'was'not'in'regular'use'with'only'8%'of'case'notes'containing'a'copy.'

Introduc9on'

'''

NICE' provide' evidenceXbased' guidance' for' the'prescrip9on' of' medica9on' used' to' treat' schoolXaged' children' diagnosed' with' severe' ADHD.' An'audit' undertaken' locally' in' 2014' evidenced' that'prescribing' standards' were' not' consistently'recorded' in' the' pa9ent’s' notes.' As' part' of'changes' to' prac9ce,' an' ADHD' Prescribing'Proforma' was' introduced' throughout' the'department' to' improve' the'quality'and'clarity'of'prescribing' documenta9on' and' thus' enhance'pa9ent'safety.''

Method''

Hospital' coding' was' used' to' iden9fy' children'commencing' ADHD'medica9on' in' 2016' at' Poole'Hospital.' Retrospec9ve'analysis' of'medical' notes'was' carried' out' to' review' documenta9on' of'the' medica9on' prescrip9ons.' NICE' CG72' was'used' as' the' gold' standard'with' a' 9me'period' of'‘within'3'months’'used'for'the'observa9ons'taken'prior'to'medica9on'commencing.''

'''

Results'!

Fig!1:!POSITIVE!PRACTICE!!

100%! !pa9ents'received'first'line'medica9on''

100%' 'pa9ents'were'schoolXaged''

97%' 'prescrip9ons'ini9ated'by'professionals''with'exper9se'in'ADHD'

0%'

10%'

20%'

30%'

40%'

50%'

60%'

70%'

80%'

90%'

100%'

BP' Heart'Rate' Height'' Weight'

Percen

tage!of!C

ases!

Fig.!2:!BASELINE!OBSERVATIONS!Recorded' Not'recorded'

10'

20'

30'

40'

50'

60'

70'

80'

90'

100'

Part'of'Comprehensive'Treatment'Plan'

Moderate/Severe'ADHD' Considera9on'of'coXmorbid'condi9ons'

Percen

tage!of!C

ases!

Fig.!3:!MANAGEMENT!OF!ADHD!

Yes' No' Not'Recorded'

20'

40'

60'

80'

100'

Mental'Health'/'Social'Assessment' Substance'Misuse'/'Drug'Diversion'

Percen

tage!of!C

ases!

Fig.!5:!PREIPRESCRIPTION!ASSESSMENTS!Documented' Not'Documented'

20'

40'

60'

80'

100'

Assessment'of'Cardiac'PMH'

Asssessment'of'Cardiac'FHx'

ECG' ECG'if'Posi9ve'FHx'Iden9fied'

Percen

tage!of!C

ases!

Fig.!4:!CARDIAC!ASSESSMENT!Documented' Not'Documented'

Similar' to' 2014' audit' data,' documenta9on' in' ADHD'prescribing'remained'substandard'and'did'not'meet'the'gold'standards' of'NICE'CG72.' The' study'was'however' limited'by'an' awareness' that' wri=en' documenta9on' may' not' fully'reflect' true' clinical' prac9ce' and' that' the' interpreta9on' of'qualita9ve'data'is,'to'an'extent,'subjec9ve.''

Through'presen9ng'the'data'&'talking'to'clinicians,'it'became'apparent' that' some' were' not' aware' of' the' prescribing'proforma'or'did'not'have'access'to' it.'Others'were'resistant'to' using' something' that' was' felt' to' be' 9meXconsuming' or'dictatorial'to'their'prac9ce'ager'years'of'experience.''

Subsequently,'an'abbreviated'‘prescribing'checklist’'has'been'created'in'conjunc9on'with'prescribers'(Fig.'6),'focussing'on'the'weaker' areas' of' documenta9on.' It' aims' to' being'more'user' friendly' whilst' s9ll' promp9ng' the' prescriber' to' meet'prescribing'gold'standards'and'improve'prescrip9on'safety.'

Conclusion'&'Changes'to'Prac9ce'Fig.'6:'ADHD'PREXPRESCRIPTION'

ASSESSMENT'FORM'

ADHD Treatment - Harmful Effects - ADHD Medication

Best Practices: Eight Principles for Safer Opioid Prescribing · Planning Committee, Disclosures • Vitaly Gordin, MD Director of Pain Division Penn State Hershey Medical Center

Safer, Faster, Better? Evaluating Electronic Prescribing · Safer, Faster, Better? Evaluating Electronic Prescribing Report to the Patient Safety Research Programme (Policy Research

Health Information Exchange Coordinating Committee (HIECC) · 2018-09-18 · Controlled Substances (EPCS) ... – Encourage safer prescribing of controlled substances and to reduce

NHSL ADHD Prescribing Guideline

NHSL ADHD Prescribing Guideline - nhslcg.scot.nhs.uk · NHSL ADHD Prescribing Guideline 4 Version 3.0 Approved June 2020 1.0 Aim The aim of this document is to provide guidance and

Prescribing Video Games (not Medication) for ADHD: How to Make it Work

Summary: Progressive Opioid Prescribing … Progressive Opioid Prescribing Guidelines for a Safer Ohio From Emergency Department & Acute Care Facilities For Chronic, Non -Terminal

The Basics of Safely Prescribing Medications for ADHD with Job Corps Students David Kraft, MD, MPH Region 1 Mental Health Specialist John Kulig, MD, MPH

Repeat prescribing: 10 tips to develop a safer system€¦ · Repeat prescribing: 10 tips to develop a safer system Liz Price Failure of repeat prescribing systems can contribute