Aims To improve prescribing on the neonatal unit.

• To assess whether current prescribing practice is in line with local prescribing guideline

• To consider whether poor audit results align with the number of prescribing datix reports

• To circulate audit results with all neonatal prescribers to improve good prescribing practice

Method The neonatal unit (comprising of intensive care, high dependency care and special care) is currently using paper Kardex prescribing. A monthly prescription audit has been common practice on the tertiary unit for a number of years and was introduced due to high numbers of datix reports relating to prescribing. We present prescribing audit findings over a 12 month period (Sept 2021- Sept 2022). 26 audit standards were identified from local prescribing guidelines. Two cohorts of junior doctors rotated in the neonatal unit during the study period. A wide range of staff participate in the monthly drug kardex audit and two staff members audit the same kardex to reduce audit bias. Departmental Pharmacist facilitated all audit sessions. Audit results from the previous month were shared with the wider audience to improve good prescribing practice. Microsoft®excel was used for data analyses. Results are presented in percentage (median). As most audit standards were consistently met, we used the minimum achieved criteria from the spread to correlate to datix. ANOVA was used to compare audit data between two cohorts of junior doctors.

Results A total of 240 drug kardex reviews completed during the study period by a mix of 30 prescribers (including Consultants, ANNPs, tier 1 and tier 2 doctors). There was no significant variation in practice between the two cohorts of junior doctors (p = 0.89). Prescription datix reports did not correlate to achieving or not achieving audit standards. Standards with poor compliance include incorrect infant demographics, missing prescriber identification details and incorrect cancellation methods (prescriptions not cancelled as per local prescribing guideline). Standard compliance consistently above 85%.

Conclusions Engaging prescribers in a multi cycle prescribing audit helped to achieve high prescribing standards consistently (>85% audit standards met most times). The presence of a departmental pharmacist at the monthly kardex audit meetings helped to reinforce good prescribing practice. Despite repeated audit measures, human factors seem to be the most important contributor to the number of prescribing errors.

Next steps: to transition to electronic prescribing. To review the local prescribing guideline in anticipation for electronic prescribing and amend the prescribing audit standards. To continue monthly prescribing audits and to continue to share good practice amongst neonatal prescribers.