Zlatin Milanov
Accurate prescribing at clerking is fundamental to patient safety in Same Day Emergency Care (SDEC), where omissions can result in rapid clinical deterioration. A two-week audit in a surgical SDEC unit at Norfolk and Norwich University Hospital identified significant safety gaps, with overall prescribing compliance of just 40%.
Critical omissions included regular medications for chronic conditions such as diabetes, epilepsy, and hypertension, alongside inconsistent prescribing of analgesia and antiemetics. Compliance with venous thromboembolism (VTE) risk assessment and prophylaxis was also poor, exposing patients to preventable harm. Notably, inappropriate prescribing was also identified, including cases where patients with bowel obstruction were prescribed laxatives, highlighting risks associated with non-standardised prescribing.
A targeted intervention was implemented, addressing both system and behavioural factors. This included a standardised gastrointestinal surgical prescribing protocol embedded within the Electronic Prescribing and Medicines Administration (EPMA) system, structured teaching sessions, incorporation into junior doctor induction, and visual prompts within clinical areas.
On re-audit, overall prescribing compliance improved from 40% to 85%. VTE risk assessment completion increased from 45% to 90%, with appropriate prophylaxis rising from 50% to 88%. Prescribing of regular medications improved markedly.
This project demonstrates that targeted, low-cost interventions can deliver rapid and substantial improvements in prescribing safety within high-turnover surgical pathways. By combining system standardisation with early clinician education, this model is highly scalable and directly aligned with national priorities for safer, more efficient day-case care. We saw the greatest improvement through the addition of the prescribing protocol.
Authors
Zlatin Milanov
Norfolk & Norwich, Norwich, United Kingdom