Safer Prescribing in ADHD - Aligning Documentation with NICE Guidelines -
Wright'S'Paediatric'ST5'
Poole'Hospital'NHS'Founda9on'Trust'
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1. A=en9on'Deficit'Hyperac9vity'Disorder:'Diagnosis'&'Management'(CG'72) '2.''''ADHD'Audit'(2014),'Poole'NHS'Founda9on'Trust''
References''''
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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'
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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.''
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Results'!
Fig!1:!POSITIVE!PRACTICE!!
100%! !pa9ents'received'first'line'medica9on''
100%' 'pa9ents'were'schoolXaged''
97%' 'prescrip9ons'ini9ated'by'professionals''with'exper9se'in'ADHD'
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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'
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Part'of'Comprehensive'Treatment'Plan'
Moderate/Severe'ADHD' Considera9on'of'coXmorbid'condi9ons'
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tage!of!C
ases!
Fig.!3:!MANAGEMENT!OF!ADHD!
Yes' No' Not'Recorded'
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Mental'Health'/'Social'Assessment' Substance'Misuse'/'Drug'Diversion'
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tage!of!C
ases!
Fig.!5:!PREIPRESCRIPTION!ASSESSMENTS!Documented' Not'Documented'
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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'
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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'
