Quality improvement project: improving junior doctors' confidence in prescribing at end of life for acute inpatients (2022)

Type of publication:Conference abstract

Author(s):*Dewhirst L.; *Hudson H.

Citation:BMJ Supportive and Palliative Care. Conference: Palliative Care Congress 1 Specialty: 3 Settings – Home, Hospice, Hospital. Telford United Kingdom. 10(Supplement 1) (pp A14), 2020. Date of Publication: March 2020

Abstract:Background Junior doctors are often at the forefront of prescribing for acute inpatients. It is imperative that they are equipped with the knowledge and confidence to prescribe appropriately for patients at the end of their life. We felt that there was reduced awareness of the need for individualised prescribing for patients with relatively common chronic diseases such as Parkinson's disease and epilepsy. Recognising that prescribing end of life medications for patients with such diseases can differ, we looked to improve symptom management by focussing on improving end of life prescribing. Methods A pre-intervention questionnaire was used to assess subjective confidence levels in prescribing anticipatory medications, syringe drivers, and individualised prescribing for patients with Parkinson's disease, end-stage renal disease, epilepsy, end-stage heart failure, and diabetes mellitus. Based on these findings a prescribing handbook was produced, incorporating consultant advice from relevant specialities. Teaching sessions were carried out using case-based discussions alongside the handbook content. A local press release facilitated dissemination of the handbook. A post-intervention questionnaire was then distributed to reassess prescribers' confidence levels. Results Twenty-five allied health professionals (mainly foundation doctors) completed the questionnaires. The preintervention questionnaire found that the majority were confident in prescribing anticipatory medication but were significantly less confident in prescribing syringe drivers and in individualised prescribing. Following formal education and release of the prescribing handbook, higher confidence levels were reported throughout all themes of the questionnaire. Conclusions This quality improvement project has significantly increased prescribers' confidence levels in end of life prescribing. It has also increased awareness of the need for alternative approaches to prescribing for certain individuals and diseases at the end of life. It was stressed that the handbook is to be used as a guide and should not replace the need to escalate concerns to the relevant specialities and the in-house palliative care team.

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Improving Oxygen Delivery on Wards (2017)

Type of publication:
Post on the Academy of Fab NHS Stuff website

*Nawaid Ahmad

Full text:
Oxygen (O2) is a drug and should be prescribed if administered to a patient. The British Thoracic Society has published guidelines on emergency oxygen delivery and a recent audit showed that out of 100 patients on O2, 42 did not have a written order.

Cycle 1: 2 FY1s collected data on O2 prescription and delivery on the respiratory ward at the Princess Royal Hospital, a part of the Shrewsbury and Telford Hospital NHS trust. At our trust, O2 is prescribed on the patient’s drug chart and saturation targets are mentioned on the prescription. 61% patients on O2 had a written order and 58% had the target mentioned along with the prescription.


Cycle 2: After the data collection, we started doing face to face education about O2 prescription in the acute medical unit and the respiratory ward. We targeted the Drs, nurses and the health care assistants. This was done for a week. A prompt card was developed (Pic 1) which was attached next to the O2 delivery system on the wall to prompt nurses to get the O2 prescribed. A card mentioning O2 targets was attached to the board above the patients bed. Another data collection was done a month later which showed that O2 prescription rates had gone up to 79% and 77% had a target mentioned.

Cycle 3: This involved forming an O2 team comprising the 2FY1s, one staff nurse and one healthcare assistant from the ward. They are called ‘O2 Ninjas’ and wear a badge (Pic 2). Their main role now will be to continue the education of all staff, each at their own level. We plan to roll out an educational programme through the trust staff education department and teach using scenarios. The idea is to spread this process to other specialties within the trust. Work is on going.

Our Motto: “ An idea needs to become a movement, for change to happen”

Link to more details or full-text: http://fabnhsstuff.net/2017/05/27/improving-oxygen-delivery-wards/