Enhancing awareness of safe medication prescribing to improve patient care in Singapore General Hospital.

Abstract

Unsafe medication practices remain a leading cause of avoidable harm globally, with an estimated annual cost of US$42 billion. At Singapore General Hospital, 32 preventable medication errors were reported in Ward 64A/C between July and December 2022, of which 81.3% were medication-ordering errors, highlighting prescribing as a key priority for improvement. The project aimed to reduce reported medication-ordering errors in Ward 64A/C from a baseline median of three per month to zero between January and December 2023.Using the Model for Improvement framework, two Plan-Do-Study-Act cycles were implemented. The first introduced structured training for junior doctors, ward-based reminders and a peer-led 'Prescribing Champion' role to improve prescribing awareness and medication-order verification. The second engaged speech therapists to integrate swallowing assessments into prescribing decisions, reducing errors from inappropriate modification of oral medications. Interventions were supported by senior leadership and reinforced through educational materials and real-time feedback.The project achieved its goal, with reported medication-ordering errors reduced to zero during the intervention and sustained through August 2024. Based on local estimates of medication-related harm, the reduction in reported medication-ordering errors may have contributed to cost avoidance of approximately SGD 18 000 annually. Staff feedback suggested engagement with prescribing safety practices, while informal patient feedback suggested greater reassurance and understanding of medication changes. The initiative was extended to Ward 46 in September 2023, where similar reductions in reported medication-ordering errors were observed. Prescribing safety training was subsequently embedded into the hospital-wide Postgraduate Year 1 induction programme.This project suggests that structured education, peer support and multidisciplinary collaboration may contribute to reductions in reported medication-ordering errors and sustained improvement in busy wards. The lessons learnt from this project may inform the design and implementation of similar medication safety initiatives aimed at strengthening prescribing practices and reducing medication-related harm.