Objective To develop and evaluate a written prescribing test for new paediatric doctors at St Mary's Hospital, London.
Methods To address the rise in paediatric prescribing errors reported in March and September (six errors/month, compared with an average of 2.2 errors/month throughout the year), which coincides with the arrival of new doctors, a practical pharmacy induction session was introduced. The format and concepts from the Imperial College Healthcare NHS Trust Mandatory Medicines Management Training module1 were used, together with the London Deanery paediatric safe prescribing presentation.2 A senior paediatric pharmacist and two senior paediatric trainees designed the session, a fictitious case scenario. Doctors were given copies of the local drug chart, and a BNFC, and asked to prescribe the medication required. The case covered important prescribing principles, such paediatric prescribing, drug interactions and the prescribing of fluids. Charts were identified by the doctor's name, and were collected for review and marking. This allowed an introduction to the local drug chart as well as individual doctor assessment. A feedback questionnaire was sent to participants after the session.
Results 22 doctors attended the session. Any incorrect, illegible or unclear prescriptions were identified. Only 2/22 (9%) of prescriptions had no errors; two major problems were identified. First, 11/22 (50%) intravenous aciclovir prescriptions were incorrect, due to wrong selection of dose and failure to identify the dose increase required in immunocompromised patients. Second, 13/22 (60%) of doctors prescribed intravenous fluids unclearly. In 11/13 (85%) cases, there was no documentation explaining the fluid calculation, resulting in an unclear instruction regarding infusion duration. There were two 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 questionnaire, 12 (92%) felt the session had been helpful and 11 (85%) felt it was valuable to have both doctor and pharmacist input. 5/13 (39%) doctors had participated in similar prescribing exercises of which 3/5 (60%) included a written test. 12 (92%) felt it was useful to have the introduction to the local drug chart, and that it was useful to teach the prescribing of intravenous fluid; 7 (54%) felt the session had subsequently improved their prescribing.
Conclusion The pharmacy induction session offered a good opportunity to improve the prescribing of new doctors starting at the Trust. It 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 over the next few intakes of junior doctors to see if the number of reported errors decreases.
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