No training was provided on the use of either chart although all participants were already http://www.selleckchem.com/products/Imatinib(STI571).html familiar with using the ICHNT chart in their clinical practice. To enhance realism, prescribers completed the assessment during normal working hours in actual patient care units (eg, ward or emergency department). Such in situ simulation, physically integrated into the clinical environment, provides greater realism than similar simulations in an alternative environment such as a classroom setting.22 Completed prescription charts were audited against predetermined standards for safe and good quality prescription writing (see online supplementary appendix 1). Analysis In the exploratory phase, the different prescription

charts in use across the NHS as well as the 40 completed prescription charts were subject to evaluation against the predetermined criteria. Focus group and observational

data were thematically analysed and agreement sought between two reviewers over key findings. In reference to the charts completed in the insitu simulations, one physician and one pharmacy student separately examined the prescription charts. Data were entered into Excel and then transferred to SPSS (V.22.0. Armonk, New York, USA: IBM Corp) for analysis. For each of the different prescription tasks, we wanted to test whether there was a significant difference between the IDEAS and ICHNT charts for a range of different outcome measures (eg, completion of information on indication or duration of anti-infectives, ability to identify the prescriber). Fisher’s exact test with a Holm-Bonferroni correction was used to correct for false-positive results arising from multiple comparisons. This allows for a family-wise significance level of 0.05, while maintaining good power. Results Phase 1: exploratory phase There was wide variety in terms of design and content between the 15 different

NHS prescription charts examined (see online supplementary appendix 2). Most charts used a booklet format; these ranged in length from 6 to 12 pages. All charts examined—including the ICHNT chart—failed on at least one of the AoMRC standards for the design of hospital prescription charts.11 A review of 40 completed prescription charts at ICHNT revealed that demographic information about the patient was generally completed to a Carfilzomib high standard. Allergies were documented for 10/40 (25%) patients although the complete type of reaction was only fully completed for 3/10 (30%) of these. Overall, 22/350 (6%) of the ‘regular’ medication orders and 10/101 (10%) of the ‘as required’ medications reviewed were deemed illegible by the reviewers and as such constituted a prescribing error.23 For 313/350 (89%) of the ‘regular’ medication orders and 92/101 (91%) of ‘as required’ medications, the prescriber could not be identified. Antibiotics were prescribed for 18/40 (45%) of the patients at some point during their inpatient stay.