Improving the prescribing practice of newly-qualified doctors

July 26, 2018, University of Exeter

It is known that prescribing errors in hospitals are common and that junior doctors may make more mistakes than senior doctors as they write the most prescriptions in hospital settings.

In a recent collaborative project, Karen Mattick, Professor of Medical Education at the University of Exeter Medical School, led a team from the Royal Devon and Exeter Hospital (RD&E) consisting of a Clinical Pharmacist, Antimicrobial Pharmacist, Clinical Pharmacy Manager and a Consultant Surgeon to see if there was a way of supporting junior to improve their prescribing capabilities.

Karen Mattick explains: "We were aware that prescribing errors are common and that junior doctors were an important target group for interventions, since they may make more mistakes than senior doctors and write the most prescriptions in hospital settings. Recent research highlights an important role for pharmacists in supporting junior doctors to improve their prescribing capabilities. We were also aware that performance feedback is likely to have significant educational impact."

Odran Farrell, Clinical Pharmacist says: "We developed and implemented a simple prescribing feedback intervention as we kept hearing that junior doctors were getting very little in the way of feedback. We devised a pharmacist-led feedback project for junior doctors, where we filmed them taking the drug histories of real patients and writing up their drug charts, with a Go Pro camera. A pharmacist then watched the footage and met with the junior doctor to review it together, discuss the good aspects of their practice and explore where there were areas to improve on."

Karen continues: "In the pilot at the RD&E, sixteen of twenty five (64%) junior doctors rotating through the surgical admissions unit of RD&E received feedback on their prescribing. The 40% reduction in the number of interventions (each equating to a prescribing error in some form) after implementation was impressive. Most prescribing errors would have had minimal risk of harm to patients but a small number of errors were more serious."

On reviewing the video footage, junior doctors that took part and pharmacists noted the distracting locations they had chosen to prescribe medicines and complete documentation. One junior doctor commented "Probably the thing I think I learnt the most was watching how many times I got interrupted whilst prescribing. A drug chart takes 10 minutes I think I got interrupted 12 times during the process!" After the project, many junior doctors used quiet office space instead of the busy ward to undertake this task.

Odran concluded: "We concluded that everyone benefits from junior doctors receiving on their prescribing practice – and pharmacists are well placed to provide it. The use of video-based reflection, for example in the environment in which prescriptions are written, has led to behaviour change. Implementing this approach more widely would reduce prescription errors still further and improve support and development of . Going forward we are looking at ways we can incorporate this into daily process."

Explore further: Pharmacist education may cut junior doctor prescription errors

Related Stories

Pharmacist education may cut junior doctor prescription errors

January 29, 2018
(HealthDay)—Pharmacist feedback and education is effective at reducing prescription writing errors by junior doctors in an inpatient setting, according to a study published online Jan. 24 in the Journal of Pharmacy Practice ...

Should pharmacists be allowed to write prescriptions?

June 20, 2018
Prescribing of medications has traditionally been restricted to physicians, but there is growing support to allow pharmacists to do so as well. A British Journal of Clinical Pharmacology review of a large number of studies ...

NHS prescribing errors puts patients at risk, warn Leicester academics

April 30, 2013
Researchers at the University of Leicester are aiming to improve the prescribing behaviour of junior doctors in the NHS which will save lives as well as time and money.

GP Prescribing a good standard but improvement possible

May 2, 2012
(Medical Xpress) -- A major study of GP prescribing, led by The University of Nottingham, has found that while the vast majority of prescriptions written by family doctors are appropriate and effectively monitored, around ...

Junior doctors have a tough job, but preparing for mishaps can help

August 10, 2017
Thousands of newly qualified junior doctors headed into UK NHS hospitals in their droves earlier this month, to begin their in-house training.

New York's stringent paperless-prescribing law takes effect

March 28, 2016
New York is putting an end to most paper prescriptions for medicine as the nation's toughest electronic-prescribing law takes effect.

Recommended for you

US approves first generic competitor to Mylan's EpiPen

August 16, 2018
US regulators Thursday approved the first generic alternative for the EpiPen, a life-saving emergency allergy medicine, two years after soaring prices for the original version owned by Mylan stoked controversy.

Study: What patients really think about opioid vs non-opioid medications for chronic pain

August 14, 2018
Prescriptions of opioids for chronic pain has increased dramatically since the 1990s in spite of their known harms. Despite a shortage of scientific studies on the long-term effectiveness of opioids such as morphine, oxycodone ...

Doctors nudged by overdose letter prescribe fewer opioids

August 9, 2018
In a novel experiment, doctors got a letter from the medical examiner's office telling them of their patient's fatal overdose. The response: They started prescribing fewer opioids.

Benzodiazepine and related drug prescriptions have increased among young people in Sweden

August 7, 2018
The prevalence rate of prescriptions for benzodiazepines and benzodiazepine-related drugs (BZD)—medications used to treat anxiety, insomnia, epilepsy and other neuropsychiatric conditions—increased by 22% between 2006 ...

Unwise opioids for wisdom teeth: Study shows link to long-term use in teens and young adults

August 7, 2018
Getting wisdom teeth removed may be a rite of passage for many teens and young adults, but the opioid painkiller prescriptions that many of them receive could set them on a path to long-term opioid use, a new study finds.

Behavioral nudges lead to striking drop in prescriptions of potent antipsychotic

August 1, 2018
A study led by Columbia University's Mailman School of Public Health has found that letters targeting high prescribers of Seroquel (quetiapine), an antipsychotic with potentially harmful side effects in the elderly, significantly ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.