Health Quality & Safety Commission | National medication chart – review and design changes

In February 2011, West Coast District Health Board (DHB) became the first DHB to implement the national medication chart. Twelve months later, a review of the seven-day chart design began. The final design sought to balance the needs of all clinicians (ie, prescribers, administrators and dispensers) and the needs of all patient populations (ie, medical, surgical, mental health) while maintaining the medication safety principles on which the original chart design had been based.

The review was based on feedback received from clinicians:

• via the electronic change register
• during the year from DHBs via email or in person
• during the long-stay chart pilot focus groups undertaken in four DHBs.

The review was also an opportunity to incorporate the paediatric charting requirements, after a separate consultation on paediatric requirements was conducted in February 2012.

One of the recurring themes in the electronic change register was the need for a long-stay chart to reduce the re-prescribing required on long-stay wards and the possible transcription errors that could result. The long-stay chart pilot was conducted in four DHBs during 2011 and the feedback from the focus groups and the available audit results were used to inform the design of the new 16-day chart.

The main changes to the chart design are:

• simplified front page requirements, ie, ‘Yes’ boxes taken out of the allergies and adverse reaction, special care required and supplementary chart sections
• addition of a barcode and a perforated cutting line for hospitals that need to scan the chart for document storage purposes
• the number of days has been increased from seven to eight to facilitate re-prescribing at weekly team meetings
• the introduction of a 16-day chart
• the number of medicines on a page has been increased in response to change requests that highlighted a difficulty in reviewing medicines when multiple pages had to be viewed
• the number of medicines on the ‘as required (PRN) medicine page’ has been increased in response to the needs of some surgical patients
• the number of administration time intervals has been reduced to create the space for the extra medicine lines
• a venous thromboembolism (VTE) prevention section has been included at the top of the regular prescribing page in response to requests from both the national VTE working party and individual DHBs
• paediatric requirements have been incorporated, ie, space to document the medicine dose calculation, ie, mg/kg/dose, an extra space to record weight, space for body surface area and gestational age
• the dose box design has been changed to clearly indicate where dose ranges should be prescribed and to highlight the figures before and after the decimal point.

The Medication Safety Expert Advisory Group has agreed that a short-stay/one-day chart should be added to the suite of national medication charts. It is planned to have this chart available by the end of 2012.

Each DHB has a lead who coordinates ordering medication charts. If your organisation would like to start using the charts, please discuss this with your medication safety team.

Posters highlighting the changes to the chart are being sent out to NMC key contacts at DHBs on Friday 31 August 2012. The posters may also be viewed and printed on the link below.