Supporting junior doctors to prescribe better
What is the problem?
Prescribing medicines is a complex and challenging task. Safe and appropriate prescribing requires clinicians to understand, consider and balance multiple and competing factors. Junior doctors are responsible for the majority of in-hospital prescribing of medicines and research shows they are also responsible for most of the prescribing errors that occur.
What are we trying to achieve?
Many junior clinicians, especially first year postgraduate doctors, report that they feel ill-equipped and unsupported to prescribe safely or rationally. Traditional approaches to junior doctor training on prescribing have tended to be informal and ad-hoc. Junior doctors are expected to learn by observing the prescribing practice of their more senior colleagues. The implication of this approach means that the quality of prescribing can be variable.
Our aim is to provide better training and support for junior doctors in order to improve their prescribing practice and to:
- ensure medicines are prescribed safely
- reduce the potential for prescribing errors
What have we done?
We have adopted an educational approach known as “academic detailing” which aims to provide junior doctors with unbiased, evidence-based, practical and non-commercial information to facilitate good clinical decision making. Clinical pharmacists, with their expertise and experience in safe medicines use, provide regular support and teaching to junior doctors on safe and rational prescribing as part of their year-long training programme (see model below).
Junior doctor (RMO) training program including Safe Prescribing module
Safe Prescribing Program
The design of the Safe Prescribing program included:
- short case studies delivered by pharmacists, highlighting both good and imperfect prescribing practice and the impact on patients
- integrating teaching with senior doctors, creating a common purpose and shared understanding of how this could be used to support the junior doctors prescribing. co-teaching with Senior Medical Staff also provided the opportunity to role model working together, and the two professions complement each other’s knowledge really well
- developing a number of interactive teaching sessions to help the junior doctors understand some of the complexities of how patients use or understand how to use their medicines. We used practical scenarios which junior doctors commonly encountered in day-to-day practice to facilitate learning
Did we make a difference?
Feedback from the junior doctors has been overwhelming positive. The pharmacists’ knowledge and practical approach to prescribing practice is seen as helpful and complementary to their senior doctor teaching and support.
The quality of prescribing practice has been audited and we have seen significant improvements in ensuring documentation of the correct patient as well as the following (see chart below):
- 25% improvement in the documentation of allergy and adverse event status
- 100% achievement in the correct use of decimal point and legibility
- 50% reduction in the use of unacceptable abbreviations
- 40% increase in the uptake of e-learning tools
Where to from here?
We are formalising the junior doctors learning by including medication safety learning objectives into their learning packages during this first year of practice. These are linked to the area of work eg surgery or general medicine.
We are also championing pharmacists as educators and role models for prescribing practice. The next step is to formalise pharmacists role in supervising prescribing practice, in order to provide evidence to their educational supervisors and consultants that they are actively engaged in this medication safety agenda.