Poster by Dr. Simon Corcoran, Dr. Robert Ferris, Dr. Ahmed Abdelaziz Ahmed, Mr. Paul Doolan and Dr. Claire O'Brien. This poster details the process of the re-design of the drug kardex at University Hospital Kerry, Ireland, by Drs. Corcoran and O'Brien, Mr. Doolan and Dr. Síle O'Connor with the goal of improving prescribing quality and patient safety. This poster was presented at the Irish National Quality, Clinical Risk and Patient Safety Conference at the RDS, Dublin in November 2019. Slides for educational purposes only. No payment or financial gain was received for this work.

1. DESIGNING A NEW DRUG KARDEX TO IMPROVE THE QUALITY OF
PRESCRIBING & PATIENT SAFETY AT UNIVERSITY HOSPITAL KERRY
Dr. Simon Corcoran, Dr. Robert Ferris, Dr. Ahmed Abdelaziz, Mr. Paul Doolan, Dr. Claire O’Brien
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PRESCRIBING ERRORS:
- Every medication administered to a patient in hospital is
prescribed in a drug kardex.
- Prescribing errors are one of the most preventable causes of
patient injury.
- A prescribing error is an incorrect drug selection for a patient
and can be the incorrect dose, frequency, route or indication;
specific contraindications to medication or failure to comply
with the legal requirements for prescription writing.
- In 2016, there were over 5,505 medication incidents
reported over 50 acute hospitals in Ireland[1].
- A review of medication incident reported in Irish hospitals
highlighted anticoagulant prescribing, the use of antibiotics
and allergies as areas of high risk[1].
DRIVER FOR PATIENT SAFETY & QUALITY IMPROVEMENT:
- An audit on prescribing practices at University Hospital Kerry
(UHK) was performed in November 2017 by Dr. Simon
Corcoran which reviewed how doctors prescribed medication
in the UHK drug kardex. The audit reviewed the drug kardex
from a set of patients from each specialty admitted to UHK
during November 2017 and the results of this audit
prompted a review of the drug kardex.
- The issue was raised with the Drugs & Therapeutics
Committee who provides overall governance of medication
use throughout the hospital and consists of a panel of
consultants, senior nursing staff, pharmacists and dieticians.
- A new UHK drug kardex was considered and its aim was to
improve patient safety; the quality of prescribing and the
administration of medication among doctors and nurses
respectively.
- The Drugs & Therapeutics Committee nominated Dr.
Corcoran as Lead NCHD and tasked him to design a new drug
kardex for the hospital.
- The new UHK drug kardex was originally based on the current
Cork University Hospital (CUH) drug kardex but was modified
to include sections from the old UHK drug kardex.
- The new UHK drug kardex was reviewed on subsequent
committee meetings and modified through feedback from
members of the committee.
- The modified UHK drug kardex was issued to each wards in
UHK on the 1st of August 2018.
CHALLENGES & SUPPORTS:
- Staff were initially hesitant with the new UHK drug kardex
however teaching sessions on medication prescribing and
administration were given during the interim period.
- Feedback from each ward was compiled by the Drugs &
Therapeutics Committee and was incorporated to further
modify the UHK drug kardex and improvements were made.
- Further auditing of the UHK drug kardex by Dr. Corcoran was
performed in November 2018 and June/July 2019 and the
results were submitted to the UHK Quality and Patient Safety
committee and presentations were given to the medical staff
and consultants were enthusiastic about the new drug
kardex.
- A prescribing tutorial was added to the induction of new
doctors starting in UHK in July 2019 with emphasis on
appropriate prescribing and common prescribing errors.
- The final version of the UHK drug kardex was signed off in
October 2019 by the Drugs & Therapeutics Committee and
will be reviewed in two years.
FIGURE 1: TIMELINE OF UHK DRUG KARDEX PROJECT
FIGURE 2: COMPARISON OF KARDEX SECTIONS (OLD VS. NEW) FIGURE 3: IMPORTANT ADDITIONS TO THE NEW UHK KARDEX
OUTCOME:
- Prescribing errors are one of
the most preventable causes
of patient injury.
- The NTMA review on
medication incident reporting
in Irish hospitals has
demonstrated that allergies,
anticoagulant prescribing and
antimicrobial prescribing are
the main cause of
preventable errors among
patients [1].
- UHK took the initiative to
reduce adverse drug events
by introducing a new drug
kardex .
- The new UHK drug kardex
and subsequent auditing has
resulting in the following
changes at UHK:
- Dedicated pharmacist in
A&E filling out medication
reconciliation of patients
admitted from A&E.
- Dedicated pharmacist for
Inpatient Palliative Unit.
- The introduction of a
prescribing tutorial at
induction of new doctors
starting in UHK.
- Improved awareness in
common prescribing
errors among doctors .
- Improvement in the
quality or prescribing
among doctors.
- Improvement of safe
administration of
medications among
nursing staff.
- Improved patient safety
KARDEX IMPROVEMENTS:
- Medication Reconciliation.
- Thromboprophylaxis
assessment.
- Separate section for
thromboprophylaxis
prescribing.
- Separate section for MRSA &
Gentamicin & Vancomycin
prescribing with instructions.
- Improved antimicrobial
courses section.
- New medication box and
medications on discharge box
to help doctors with discharge
letters.
- Colour coded sections
(antimicrobials – yellow;
thromboprophylaxis – purple;
PRN medication – green;
regular medication – white).
- Improved oxygen prescribing
section.
ACKNOWLEGEMENTS: Dr. Claire O’Brien, Consultant Physician; Dr. Sile O’Connor, Antimicrobial Pharmacist; Ms. Martina O’Connor, Senior Pharmacist; Dr. Caroline Burke, Medical Registrar; Dr. Fiona Riordan, Medical
Intern; Dr. Conor Ledingham, Medical Intern; Dr. Niamh Feely, Consultant Anaesthetist and UHK Clinical Director; UHK Drugs & Therapeutics Committee and the UHK Quality and Patient Safety Committee.REFERENCES:
[1] National Treasury Management Agency – Review of Medication Incident
Reported in Irish Hospitals National Learning 2016