Minimising prescription errors-a quality improvement project in the ophthalmology department in a tertiary referral hospital.

PURPOSE: The aim of this quality improvement project was to look into the hospital prescriptions and to identify and record the type and number of errors, to implement measures to reduce the risk of these errors and then to reaudit to assess the impact of changes implemented. METHODS: The initial audit was conducted prospectively over a eleven-week period. Prescriptions written by doctors of all grades and members of the staff, such as optometrists and nurses, were analysed. A glaucoma prescription guide along with more training at prescribing for doctors was introduced with a view to reducing these errors. A reaudit later demonstrated a significant reduction in these errors. RESULTS: After the introduction of a glaucoma prescription guide and more training for all grades of staff members, prescription errors reduced to 73/2342 (3.1%). Reaudit showed a reduction in both prescription writing errors 50/73(68.4%) and drug-related errors 23/73(31.6%). CONCLUSION: Prescription errors are avoidable. This audit demonstrated that providing an accessible, easy to read and understand glaucoma prescription guide in the outpatient department along with targeted training for medical staff in prescribing can help in minimising these errors and can lead to safer practice.

Outcome Following Laser Peripheral Iridotomy and Predictors of Future Lens Extraction.

PURPOSE: To examine the outcome of laser peripheral iridotomy (LPI) for primary angle closure and determine predictors of future lens extraction (LE). METHODS: A retrospective chart review of 218 eyes from 128 consecutive patients undergoing LPI between 2010 and 2012 at a university hospital. Baseline factors including age, peak intraocular pressure (IOP) before LPI, diagnosis (primary angle closure suspect, primary angle closure, primary angle closure glaucoma), and acute or non-acute presentation were recorded. Patients were followed for 3.7±1.6 years. Kaplan-Meier curves were constructed to examine survival times to LE and Cox proportional hazard regression was used to identify factors associated with LE. RESULTS: In total, 91 of 218 eyes (41.7%) initially treated with LPI had LE during follow-up. For eyes with non-acute presentation, 12%, 25%, and 32% had LE at 1, 2, and 3 years, respectively. For eyes with acute presentation, 27%, 42%, and 50% had LE at 1, 2, and 3 years. In univariable analysis, older age, higher IOP, worse visual field, and primary angle closure glaucoma diagnosis were associated with LE, with older age and higher IOP remaining significant in multivariable analysis. There was a 1.09-fold increased odds of LE for each year older at baseline and each 1 mm Hg higher IOP was associated with a 1.08-fold increased odds of LE. CONCLUSIONS: A large proportion of patients with angle closure treated with LPI went on to require LE. Patients with features associated with higher odds of LE might be considered for LE as a primary procedure.