219 Improving secondary prevention in patients with acute coronary syndrome through electronic prescribing plans, a quality improvement project

Introduction Diabetes and hypercholesterolaemia are key modifiable risk factors for coronary artery disease. Lipid profiles and Haemoglobin A1c (HbA1c) should be checked in patients presenting to hospital with Acute coronary syndrome (ACS) as per national and European guidelines. The aim of this Quality Improvement project was to improve assessment of lipid profile and HbA1c in patients referred to the acute medical take with ACS. Methods Data was collected retrospectively from the acute medical take list. An online spreadsheet was used to collect data on patient demographics, medication prescribed, and blood tests performed. Two PDSA cycles were completed, and prospective data was collected following the implementation of two set of changes. Results Three periods of data collection identified 119 patients treated for ACS. Baseline data was collected in April 2023, in which 39 patients were treated for ACS (female n=24, age=71.26± 13.4). Of the patients identified, only 21 (53.8%) had lipid profiles assessed, and 14 (35.9%) had HbA1c checked. We completed a Plan-Do-Study-Act cycle with posters in clinical areas, along with pre-filled laboratory add-on requests. This initial intervention resulted in an improvement of assessment of lipid profile and HbA1c to 71.1% and 57.9% respectively. We performed a second PDSA cycle, with addition of Lipid profile and HbA1c blood tests to the pre-existing online ACS prescribing plans. 42 patients were managed for ACS in the month following these changes (female n=17, age=71.8±13.4). Lipid profiles were assessed in 31 (73.8%) and HbA1c assessed in 25 (59.5%). Conclusion The integration of these changes within the electronic prescribing system demonstrated a persistent improvement in assessment of lipid and HbA1c in ACS patients when compared to baseline. The combination of educational and systems-based interventions represents sustainable methods of implementing of positive changes in secondary prevention of ischaemic heart disease. This project is limited by its single centre nature and small sample size, but given we recruited consecutive patients, our results may represent similar practice in larger cohorts. Conflict of Interest nil