Background Inspired by work from a number of other centres,^{1 2} a weekly ‘Druggle’ was set up on our 28 cot tertiary, level 3 neonatal intensive care unit in June 2018. The Druggle is a short pharmacist-led briefing in the clinical area involving doctors and nurses, focussing on prescribing and administration issues and errors. Over the first year a concurrent zero tolerance audit shows an improvement in prescribing practice, with an increased number of charts with zero errors (63% in June 2018, 95% in June 2019). Despite the improvements in prescribing practice, average attendance at the Druggle has fallen from 17 people per week to 7 over the year. It was decided to consider personalised feedback on prescribing as a potential new mechanism to improve and maintain prescribing standards.

Aim To investigate if structured, personalised feedback to prescribers on a neonatal unit could be an innovative way of improving prescribing standards and patient safety. The project was set up to gain an insight into prescribers attitudes towards prescribing feedback and to see what impact that feedback might have on their attitudes after it had been carried out.

Method All prescribers on the unit were invited to complete an online questionnaire which included questions on previous experience of feedback and attitudes towards structured, personalised prescribing feedback. Participants were also able to express their interest in participating in a feedback session.

A selection of prescribers who had chosen to participate were then monitored and contacted to arrange a feedback session. This comprised of a short interview style session based on Pendleton’s rules for feedback³ in which pictures of their prescriptions were appraised and a structured feedback form completed by the pharmacist was reviewed. The feedback form was split into sections covering legibility, accuracy and completeness, with each section having a non-numerical scoring system, together with practical examples and suggestions for improvement.

After the feedback session, prescribers were asked to complete a feedback response form which allowed them to express how useful they found the feedback, whether they felt it would change their practice and to give comments.

Results The initial questionnaire was completed by a wide variety of prescribers including different grades of doctor and advanced neonatal nurse practitioners (ANNPs) with a range of 0–15 years of neonatal prescribing experience. 45% of respondents had never received personalised prescribing feedback, and 90% of respondents said they would welcome it. Comments included a desire for positive feedback as well as suggestions for how to improve. Feedback sessions are still ongoing, and initial results of the post-feedback questionnaire are positive – mean score of 4.3/5 for usefulness of feedback to practice. Comments include ‘This has been the single most useful feedback for my prescribing practice to date’ – ST5 Doctor.

Conclusion Providing personalised feedback to prescribers is welcomed and should be explored more widely. Initial results show that prescribers find personalised feedback useful and they can use it as a basis for reflecting on prescribing practice.

References

1. Reece A, Hill A, Platt B, et al. G171 Improving situation awareness in prescribing: A medication safety huddle – the DRUG-gle (Druggle). Arch Dis Child 2016;101:A89.

2. Bell C, Jackson J, Shore H. P3 S.a.f.e. – the positive impact of ‘druggles’ on prescribing standards and patient safety within the neonatal intensive care environment. Arch Dis Child, 2018;103:e2.

3. Pendleton D, Schofield T, Tate P, et al. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1983.