Improving drug charting practices and documentation among nurses in emergency department at a regional hospital, Bhutan: a quality improvement initiative.

Abstract

Medication error is one of the most common safety issues and the highest prevalence rate of preventable medication-related harm is seen in low-income and middle-income countries especially in Africa and South Asian countries. Studies done elsewhere show that medication errors related to transcription and drug chart documentation can be as high as 70%. A baseline survey done in our department showed that our drug charting practices and documentation are only complete in 45% which could significantly contribute to medication errors and patient safety. To address this gap, our project aimed to improve the drug charting practices and documentation among nurses in our department from 45% to more than 90% in 8 weeks. We formed a team and implemented strategies through four plan-do-study-act cycles. Interventions included increasing sensitisation about hospital transcription protocol, standardising drug charts and monitoring of drug chart practice. The members meet every 2 weeks to discuss, analyse and plan for next intervention based on our findings at the end of every cycle. At the end of the project, the completeness of drug chart documentation improved from 45% to 98% and adherence to standard charting practices from 51% to 98% CONCLUSION: Medication transcription error is common and improving on incomplete drug chart and poor charting practices can reduce errors. Our results emphasise the importance of simple and cost-effective intervention in bringing and achieving the aim which could be implemented in other department and institutions.