R L Grant

Publications (3)3.69 Total impact

• Article: National clinical sentinel audit of evidence-based prescribing for older people.

  G M Batty, R L Grant, R Aggarwal, D Lowe, J M Potter, M G Pearson, S H D Jackson
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  ABSTRACT: To audit the performance of hospitals in evidence-based prescribing. All hospitals in England were invited to participate. The audit was completed in 62 hospitals. Prescribing and clinical data were collected on 100 consecutive medical inpatients aged >/= 65 years at each site, enabling evaluation of eight prescribing indicators before and after intervention. The data were collected using a specifically designed database. The results of the first audit were available immediately from the software and a national report with locally identifiable information was returned to hospitals. Hospitals were encouraged to design and deliver their own intervention strategy. A questionnaire was sent to all hospitals to document prioritization of indicators. Generic names were used for 36 061 (82.6%) in 1999 and 39 188 (86.4)% in 2000. In 1999, 50% (3074) of patients had documentation of allergy status. This increased to 60% (3684) in 2000. For 21.2% of patients prescribed paracetamol in 1999 and 18.1% in 2000, the prescription was written such that it was possible to exceed the maximum recommended dose of 4 g in 24 hours. Long-acting hypoglycaemic drugs were prescribed to 29 patients in 1999 and 20 patients in 2000. Anti-thrombotics were used appropriately for 54% (520/966) of patients in atrial fibrillation in the first audit and 57% (579/1019) in the second audit. The appropriate use of aspirin increased from 91% (595/651) to 94% (725/772) and the appropriate use of benzodiazepines dropped from 49% (537/1088) to 47% (460/966) between the audits. For three indicators, the allocating of a high priority translated into a bigger improvement between the audits. Local ownership of data and the quality improvement process, and provision of national benchmarking data did not result in a significant improvement in prescribing in the second audit.
  Journal of Evaluation in Clinical Practice 05/2004; 10(2):273-9. · 1.23 Impact Factor
• Article: National sentinel clinical audit of evidence‐based prescribing for older people: methodology and development

  R. L. Grant, G. M. Batty MD MRCP, R. Aggarwal MSc MRPharmS, D. Lowe MSc CStat, J. M. Potter DM FRCP, M. G. Pearson MB FRCP, A. Oborne MSc ClinPharm MRPharmS, S. H. D. Jackson MD FRCP
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  ABSTRACT: Rationale, aims and objectives This national clinical audit aimed to develop and implement a methodology to assess the appropriateness of prescribing for patients over the age of 65 in hospitals, general practice and nursing homes. Methods Organizations providing health care in the National Health Service in these three sectors were recruited into multi-disciplinary and inter-organizational local coalition teams. Prescription data and relevant clinical data were collected electronically on a customized database. The appropriateness of prescribing for specific conditions among the patients sampled was assessed by simple computerized algorithms, and users were provided with feedback to stimulate discussion and change. Use of the software tool was demonstrated to be feasible and its data reliable. Participants were re-audited, after a period of nationally guided and locally driven intervention, to evaluate levels of change. Local efforts to stimulate change and barriers to change were collected qualitatively. Results and conclusions The investigation revealed encouraging results and demonstrated the ability of audit to improve the quality of clinical services in given circumstances, although a multiplicity of questions relating to cost and methodology remain to be addressed.
  Journal of Evaluation in Clinical Practice 06/2002; 8(2):189 - 198. · 1.23 Impact Factor
• Article: National sentinel clinical audit of evidence-based prescribing for older people: methodology and development.

  R L Grant, G M Batty, R Aggarwal, D Lowe, J M Potter, M G Pearson, A Oborne, S H D Jackson
  [show abstract] [hide abstract]
  ABSTRACT: This national clinical audit aimed to develop and implement a methodology to assess the appropriateness of prescribing for patients over the age of 65 in hospitals, general practice and nursing homes. Organizations providing health care in the National Health Service in these three sectors were recruited into multi-disciplinary and inter-organizational local coalition teams. Prescription data and relevant clinical data were collected electronically on a customized database. The appropriateness of prescribing for specific conditions among the patients sampled was assessed by simple computerized algorithms, and users were provided with feedback to stimulate discussion and change. Use of the software tool was demonstrated to be feasible and its data reliable. Participants were re-audited, after a period of nationally guided and locally driven intervention, to evaluate levels of change. Local efforts to stimulate change and barriers to change were collected qualitatively. The investigation revealed encouraging results and demonstrated the ability of audit to improve the quality of clinical services in given circumstances, although a multiplicity of questions relating to cost and methodology remain to be addressed.
  Journal of Evaluation in Clinical Practice 06/2002; 8(2):189-98. · 1.23 Impact Factor