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The introduction of a prescribing test for new paediatric doctors
  1. A Kamal,
  2. J Simmons
  1. St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK

Abstract

Objective To develop and evaluate a written prescribing test for new paediatric doctors starting at a large inner city hospital.

Methods To address the rise in prescribing errors reported in March and September (6 errors/month, compared to an average of 2.2 errors/month throughout the year), coinciding with the start of new doctors, a practical induction session was introduced. The format and concepts from the Trust Mandatory Medicines Management Training module were used, together with the Deanery paediatric safe prescribing presentation.

A pharmacist and 2 trainees designed the session; a fictitious case scenario. Doctors were given a copy of the local drug chart, and a BNFC, and asked to prescribe the medication as required. The case covered important prescribing principles, such paediatric prescribing, drug interactions, and fluid prescribing etc. Charts were identified by the doctor's name, and were collected for review and marking.

A feedback questionnaire was sent to participants post session.

Results 22 doctors attended the session. Any incorrect, illegible or unclear prescriptions were identified.

Only 2/22 (9%) of prescriptions had no errors. 2 major problems were identified. Firstly, 11/22 (50%) intravenous aciclovir prescriptions were incorrect, and secondly, 13/22 (60%) of doctors prescribed intravenous fluids unclearly, mostly with no documentation explaining the fluid calculation and therefore infusion duration.

There were 2 drug charts with a number of errors. A consultant spoke to these individuals separately, and they were given additional training. An email was also circulated to the department giving feedback from the session.

Of 13/22 (59%) responses to the feedback questionnaire, 7 (54%) felt the session had subsequently improved their prescribing. 12 (92%) felt it was useful to have the introduction to the local drug chart, and the teaching on intravenous fluid prescribing.

Conclusion The pharmacy induction session offered a good opportunity to improve the prescribing of new doctors' starting at the trust. The session covered a number of paediatric prescribing principles, introduced local prescribing stationary, and was well received by participants. The assessment of individual doctors meant that additional support could be given early where needed. Future audits will assess the error rate after future intakes of doctors to see if this decreases.

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