The Pharmaceutical Journal
Vol 280 No 7496 p399
5 April 2008

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• Society elections (2)
• Devolution
• Medication errors
• Children's medicines
• The new contract
• Community pharmacy
• Patient safety
• Responsible pharmacist
• CPPE
• Education
• The Society (4)
• Pharmacy in the media

Letters to the Editor

Patient safety

Auditing medication practice

From Professor D. H. Cousins, MRPharmS

I write in response to Brian Hebron’s article entitled “Audits: pitfalls and good practice” (PJ, 1 March 2008, p250). Recognising time and resource constraints that NHS organisations face the National Patient Safety Agency took a pragmatic approach in designing our audit forms. We did not include the need to calculate sample size or confidence intervals.

Denominator data, such as the total number of patients started on anticoagulants, or children treated with hypotonic infusions, are not easily found in most organisations and would have been a barrier to audit. The NPSA identified more straightforward organisational and observational measures to provide meaningful information on the implementation of safe medication recommendations.

Over time healthcare organisations and researchers can refine audit methodology, including the use of statistical methods, to provide increased levels of information and, hopefully, produce audit reports for journal publications on the management of medication risks in the NHS.

As regards warfarin regimens and strength of tablets used, the NPSA does not recommend changing the warfarin tablet strengths for patients who are stable and coping well with their regimens. Where patients are having difficulties or where difficulties can be anticipated (eg, taking large numbers of tablets each day, alternate day dosing, or having to split tablets), then therapeutic practice should be flexible.

Allowing the use of the most appropriate tablet strengths and constant daily dosing regimens will better meet individual patients’ needs.

David Cousins
Head of Safe Medication Practice,
National Patient Safety Agency

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