71 QIP: improving the administration rates of prescribed once only medications at St Gemma’s Hospice, Leeds

Background Since the transition from paper prescribing charts to electronic there has been an ongoing issue with STAT medications being prescribed under the 'once only' tab frequently being left unadministered. This can effect patient care. Existing prompts appear on the electronic chart but it is felt that nursing staff have become 'numb' to these. This QIP aims to improve the administration of medicines that have been prescribed as once only and also improve the rate of documentation as to why they are not administered at St Gemma's Hospice. The intervention trialled was to write when a once only medication had been prescribed on treatment room white boards (viewed very regularly by nursing staff) as an additional means of communication. Methods Data was collected retrospectively between December 2022 and January 2023 including the number of once only prescriptions, the number not administered and the number unadministered with documented reasons for this. Interviews were conducted with nursing teams and themes surrounding this issue were identified. The intervention and education on this were implemented in February and the same parameters re-audited in March and April. Results 75% of nurses felt the main issue was lack of communication between prescribers and nursing team and 100% of nurses felt the proposed intervention would be helpful. In the months prior to the intervention only 75–80% of unadminsitered prescriptions had reasons for this documented. At the end of the two month intervention trial 82% of once only medications were administered and reason documentation rates for those left unadminsitered improved to 100%. Conclusion This QIP recommends long term adoption of this intervention to improve patient care. Barriers to success identified included 'change over' of junior doctors on rotation thus it is also recommended to discuss this during the induction of new doctors to the Hospice.