Increasing prescription rates for preventative medication after cardiac events

The head of the cardiology department chose to investigate the prescribing of secondary preventive medicines for patients with acute coronary syndrome. This aspect of care was chosen because it is relevant to a large proportion of patients and it is important for reducing the risk of further cardiac events.

The department head knew of the Acute Coronary Syndromes Clinical Care Standard, and the cardiac registrar found a published audit of Australian hospitals that included rates of prescribing secondary preventive medicines. The same patient inclusion and exclusion criteria from the audit were used for the hospital’s variation project so the data could be directly compared.

The resident medical officer extracted the data from the electronic records for all patients who met the criteria for each of the previous three months. The percentage of patients who were prescribed secondary preventive medicines was 60%, 70% and 65% for each of the three months. This gave an average of 65% in this snapshot period.

The published audit found an average rate of 71% across Australian hospitals, which showed the department that they were performing below average on this aspect of care.

The team also compared practice with the Acute Coronary Syndromes Clinical Care Standard, which includes this statement:

Quality Statement 6 – Individualised care plan: Before a patient with an acute coronary syndrome leaves the hospital, they are involved in the development of an individualised care plan. This plan identifies the lifestyle modifications and medicines needed to manage their risk factors.

The data were presented to the cardiology department teams, who could see they were not meeting this aspect of the standard for up to 35% of their patients over the past three months.

The department decided that this gap in care was unacceptable and required urgent action. They decided to make the Australian average rate of 71% their initial goal, and to aim for a higher benchmark in the long term.

Medical, nursing, pharmacy and allied health staff met to discuss possible reasons for the poor performance in prescribing secondary prevention medicines. A lack of a standardised process and lack of awareness of the effectiveness of secondary prevention were thought to be the main contributors.

Education sessions on recommended secondary prevention medicines were held at the regular department meetings and a discharge checklist that included prescribing secondary prevention medicines was introduced. The hospital pharmacist also provided one-on-one education sessions with medical staff.

The department used the relevant indicators in the Acute Coronary Syndromes Clinical Care Standard to monitor performance going forward. The department head also collaborated with several other similar hospitals to compare data every quarter and exchange lessons learned.