Improving drug charting practices and documentation among nurses in emergency department at a regional hospital, Bhutan: a quality improvement initiative.

INTRODUCTION: Medication error is one of the most common safety issues and the highest prevalence rate of preventable medication-related harm is seen in low-income and middle-income countries especially in Africa and South Asian countries. Studies done elsewhere show that medication errors related to transcription and drug chart documentation can be as high as 70%. A baseline survey done in our department showed that our drug charting practices and documentation are only complete in 45% which could significantly contribute to medication errors and patient safety.

METHODS: To address this gap, our project aimed to improve the drug charting practices and documentation among nurses in our department from 45% to more than 90% in 8 weeks. We formed a team and implemented strategies through four plan-do-study-act cycles. Interventions included increasing sensitisation about hospital transcription protocol, standardising drug charts and monitoring of drug chart practice. The members meet every 2 weeks to discuss, analyse and plan for next intervention based on our findings at the end of every cycle.

RESULTS: At the end of the project, the completeness of drug chart documentation improved from 45% to 98% and adherence to standard charting practices from 51% to 98% CONCLUSION: Medication transcription error is common and improving on incomplete drug chart and poor charting practices can reduce errors. Our results emphasise the importance of simple and cost-effective intervention in bringing and achieving the aim which could be implemented in other department and institutions.