As needed or pro re nata medication prescribing accuracy in haematology/oncology: quality improvement initiative

Inaccurate prescribing of as needed medications in haematology/oncology patients poses a significant risk to patient safety and symptom control. This quality improvement initiative aimed to reduce as needed prescribing errors from 30% to below 10% over 12 weeks at Galway University Hospital.

A multidisciplinary 'Medication Safety Team' was formed, and a baseline audit using point prevalence surveys revealed a 30% as needed error rate, predominantly in dose and frequency domains. Semistructured interviews with non-consultant hospital doctors (NCHDs) identified barriers such as limited knowledge of resources, time pressure and inadequate education. Four Plan-Do-Study-Act cycles were implemented focusing on tools, education, resources and awareness.

As needed prescribing errors reduced from 30% to 8%. Stakeholder feedback indicated improved confidence and clarity in prescribing practices. Sustainability is addressed with the introduction of QR-code resources at the point of care and embedding of education at induction for NCHDs.

This initiative demonstrates that structured, stakeholder-driven interventions can meaningfully improve prescribing accuracy. Systematic integration of education and resources supports long-term impact, offering a replicable model for enhancing medication safety in palliative and oncology care settings.