The Importance Of Initiating Change

Initiating change: We discussed these findings during our monthly Doctors meetings, the team were surprised by the findings but agreed that we all tend to look at the patient notes and cross off medications frequently but do not always discuss or document the changes. Both medical and none medical prescribers agreed that this could potentially result in a drug error whereby the incorrect medication had been omitted and there would not be any supporting written evidence. We revisited the General Medical Council (2016) and Nursing and Midwifery Council (2016) guidance on prescribing, and discussed issues surrounding deprescribing at length. The nurse prescribers were also involved in discussions as to how and why we stop medications and they
Barriers to change:
A new way of working can often be challenging and I think having the tool on the prescription chart would be a great idea as it acts as a clear prompt. Doctors felt that if the patient was not able to have the discussion due to them being too unwell and if there was no relative present that this would be an issue. However, we agreed that if this is the case we would still make the changes acting in the patient’s best interest but would discuss this as a team and we would ensure we documented this in the patients’
Colleagues reported that they felt that often the patient is too unwell to have those conversations with and the Doctors/Nurse prescribers do not feel it is appropriate to be “burdening” the carers with any more information regarding stopping medicines as they thought this may cause may distress, we discussed how this was actually good practice and could help open conversations with loved ones regarding the patient approaching the end of their life. It is not always possible to have these conversations as some patients so not have anyone close but we should try where we can to be open and honest. We have organised a communication skills day in the new year where we can role play some of these discussions so they do not feel as daunting.
Having completed this audit, we have highlighted several key areas for further improvement. We are going to try and move towards an electronic prescribing system which links in with the electronic patient notes, the software is already in place we all just need training on how to use this and how it will link in with our pharmacy support. In the mean time we have now added drop boxes onto our clinical notes which act as a prompt to check patient’s medication and document any changes.
Once these changes have taken effect and our staff have completed the communication skills study day I would like to