Background Prescribing errors have recently been highlighted as a significant problem; the General Medical Council commissioned a study (EQUIP) in 20091 which found the most common errors were with dosing. Whilst the EQUIP study focussed on adult prescribing the consequences of dosing errors in children are more harmful. In 2010, Ghaleb et al. Conducted a study across a range of paediatric settings in London which demonstrated a 13% prescribing error rate.2 The paediatric pharmacy team at Southampton Children's Hospital have provided prescribing teaching at doctor's induction for many years, but have recently introduced a structured scenario based assessment. This was agreed at a consultant paediatrician/care group meeting prior to starting.
Aim The aim of this work is to describe our experience of the RCPCH Paediatric Prescribing tool in assessing junior doctors starting at Southampton Children's Hospital.
Method Face-to-face teaching and case based assessment are carried out at induction using the Royal College of Paediatrics and Child Health (RCPCH) paediatric prescribing tool and assessment sheet 3.
Results Two induction assessments have been completed to date, n=21, passed n=18 and failed=3 (14%). All doctors who failed the initial test sat an alternative assessment within a week. One person failed the 2nd test and had to have their prescriptions counter-signed by designated supervisors for 1 month before re-sitting with a third set of scenarios. This meant the doctor had to be temporarily removed from the on-call rota. Only one prescribing error was identified during the one month period and the second re-sit was passed. Following a supervisors meeting the doctor was allowed to prescribe independently and reinstated onto the on-call rota.
Conclusion This report highlights our experience at Southampton Children's Hospital of using the RCPCH prescribing tool and assessment. The majority of junior doctors sitting the assessment passed. The test was able to identify individuals unable to meet the required prescribing standards who were then supported. Further discussion is needed to ensure that a safe level of cover is maintained if doctors have to be temporarily removed from on-call services.
We hope to extend the assessment to include GP trainees and other specialities and generate an on-line tool for use next year following the introduction of electronic prescribing. Discussions are on-going regarding the introduction of the assessment across the Medical Deanery as part of core training. We recommend that centres undertaking this exercise agree the measures that will be taken in the event of a failure.