089 Assessing the impact of recommendations on drug prescriptions in intensive care units

Background and Objectives The prescription is the starting line in the organisation of the drug circuit and determines the work of all those involved in the drug delivery process. The aim of our study was to assess drug prescription in the intensive care units (ICUs) of the College of intensivists of North-East France. Programme A two-round clinical audit was conducted in four ICUs. All prescriptions written out over a 24-h period were reviewed by a doctor and a pharmacist in each ICU. Criteria for good prescribing practices were established and distributed to all team members. A reminder was issued 3 months later. The second round of the clinical audit was carried out 6 months after the first. Results The number of prescriptions was 180 in the first round and 193 in the second. The non-conformity rate was 33.9% and 12.4%, respectively. The main errors in the two rounds were: adding an unsigned and unstamped (no date or time) prescription (70% vs 58%), unsigned change in dose (16% vs 9%), unsigned order to discontinue drug administration (18% vs 9%), administration of a drug that was not prescribed, no mention of dose, oral prescription, and noncompliance with dosage form. Discussion and Conclusion The dispensation and administration of a drug depends on the prescription. The main risks when prescribing drugs are the prescription of a treatment unsuited to the patient9s clinical condition, possible drug interactions and a lack of detail that may induce errors. Establishing and distributing guidelines is an essential step in reducing prescribing errors and managing drug-related risks in ICUs. In conclusion, the production and distribution of criteria helped lower the rate of non-conformity with prescriptions in ICUs. We are currently preparing Intranet distribution within our hospital of criteria for the most commonly used drugs administered by infusion or injection and a list of drugs that can be administered by gastric tube. Introduction La prescription est le point de depart d9un des processus organisationnels majeurs qu9est le circuit du medicament. Elle conduit a structurer l9organisation du travail de tous les acteurs de la dispensation a l9administration. L9objectif de notre etude est d9evaluer la prescription medicamenteuse dans les services appartenant au College des reanimateurs du Nord-Est. Methode Un audit clinique, est realise dans 4 services de reanimation. Toutes les prescriptions d9une periode de 24 heures ont ete revues par un medecin et un pharmacien dans chaque service. Un referentiel de prescription a ete realise et distribue a tous les membres des equipes medicales, avec une « piqure de rappel » a 3 mois. Un deuxieme releve a ete realise a 6 mois. Resultats 180 prescriptions ont ete relevees au premier tour, et 193 au deuxieme. Les taux de non conformite etaient de 33,9 % et de 12,4 % respectivement. Les erreurs principales qui ont ete notees sont : ajout de prescription non signee non horodatee (70 vs 58%), modification de posologie non signee(16 vs 9%), arret d9un traitement non signe (18 vs 9%), administration d9un medicament non prescrit, absence de posologie, prescription verbale et forme galenique non respectee. Discussion La qualite d9une prescription du medicament conditionne celle des autres etapes : dispensation et administration. Les principaux risques encourus a cette etape de prescription d9une ligne therapeutique sont lies a une inadequation par rapport a l9etat de sante du patient, une interaction deletere avec d9autres lignes therapeutiques et/ou une insuffisance de precision generatrice d9erreurs. La diffusion des recommandations est un element essentiel dans la maitrise des erreurs de prescription et la gestion de risque lie aux medicaments en reanimation. Resultats La realisation et la diffusion de referentiel de prescription medicamenteuse a permis de baisser le taux de non conformite des prescriptions en reanimation. Des listes de diffusion « intranet » des medicaments les plus couramment utilises avec modalites de perfusion ou d9injection ainsi que la liste des medicaments compatible avec un administration par une sonde gastrique sont en train d9etre finalisees pour etre diffusees dans notre hopital.