An Audit Spiral of the Medication Process in a Tertiary Care Hospital

Medication process is the step-by-step process followed in the delivery of a drug from the pharmacy to the patient. The various components involved in this process are 1) prescription, 2) transcription, 3) indenting, 4) dispensing, 5) storage, 6) administration, and 7) monitoring. This process is carried out by doctors, nurses, and pharmacists. Any error occurring in any step can have a deleterious effect on the patient ranging from disagreeable to life threatening. National Accreditation Board for Hospitals and Healthcare Providers (NABH) has developed standard practice guidelines to help minimise errors and ensure a safe administration. We conducted a 2-cycle medication process audit at our tertiary care surgical centre in admitted patients. Following this, errors were identified in each step and a targeted teaching program was conducted with the aim of educating and preventing future errors. New recommendations were made and put into practice. After a 3-month period, the process was re-audited. The 2 audit cycles involved 203 and 191 observations, respectively. After the first audit cycle, it was found 100% prescriptions, 96% transcriptions, and 73% drug administrations failed to meet criteria of evaluation. Two incidents of near miss were documented. During the second audit cycle, the error rates dropped to 78% of prescriptions, 42 % transcriptions, and 4% drug administration. This was statistically significant. Non-maleficence is an integral part of patient care. Therefore, as health care workers, it is vital to maintain an error-free medication process. This study has shown that an audit spiral involving a process audit followed by an educational programme improves safety, as proved by the second audit. We recommend that all healthcare facilities must undertake similar audits regularly.