Evaluation of emollient prescribing in care of the elderly inpatients

Ageing tends to have a degenerative effect on the skin and emollient use may help maintain skin integrity in older people. In the hospital setting, skin conditions can sometimes be misinterpreted as minor and therefore regular emollient prescriptions are often incomplete or inaccurate.1 We undertook a quality improvement project to evaluate the prescribing of regular emollients in care of the elderly inpatients. Baseline data were collected using electronic health records for patients in six care of the elderly wards at Northwick Park hospital. We undertook two Plan Do Study Act (PDSA) cycles to improve the accuracy and reduce the delay in regular emollient prescriptions on admission. Our interventions included posters clearly displayed in Accident and Emergency and on acute medical wards and discussions with pharmacists to alert admitting doctors when regular emollients were not prescribed appropriately over 3 months. In the first PDSA cycle 156 patients were identified, out of which 46 were on regular emollients. The proportion of timely prescriptions was 26% with a mean delay of 11.5 days. In the second cycle 150 patients were identified, out of which 30 were on regular emollients. Following our interventions, the proportion of timely prescriptions rose to 30% and the mean delay time improved to 6.6 days. Our interventions resulted in increased timely prescriptions of regular emollients and reduced prescription delay time in care of the elderly inpatients. This project highlights the need to continue to raise awareness regarding the suboptimal emollient prescribing in elderly patients on admission and hence further cycles to sustain the improvements seen are planned.