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Prescribing behaviour of Foundation Year 1 doctors Doctors are responsible for all prescriptions that they sign and ensuring that prescriptions are safe and appropriate (1). This is outlined in the Foundation Year 1 (FY1) curriculum which also recommends use of appropriate sources of support e.g. British National Formulary (BNF), electronic prescribing decision-support (2). However, previous studies have shown that FY1 prescribing errors are common (error rate of up to 8.4%)(3). The aim of this study was to assess prescribing behaviour in FY1s nearing full GMC registration and whether this behaviour is in accordance with GMC guidance and the FY1 curriculum. A 16 question survey was designed to investigate prescribing behavior and uncertainty related to new prescriptions, transcribing medicines, or taking/receiving verbal drug orders. A 5-point Likert-type scale was used (level of agreement: often, sometimes, unsure, rarely or never). The survey was sent electronically to FY1s at a London teaching hospital and paper copies were distributed at teaching sessions. 27 FY1s completed the survey; frequency of responses to individual questions varied from 24-27. New prescriptions: when prescribing an unknown drug 63% [17 of 27] would always/often use the BNF. 46% [11 of 24] stated they would “Google” the drug (individual websites not identified). FY1s more frequently did not question an unfamiliar drug and prescribe it blindly (46% [12 of 26]) than omit the drug from the chart (12% [3 of 25]). Transcribing: when transcribing a drug that was written illegibly and could not be identified, 81% [22 of 27] would ask another doctor/nurse for help. 27% [7 of 26] would always/often omit the drug from the chart if it was not recognised. However, many stated that at some point they had either prescribed what they thought the drug to be (54% [14 of 26]) or roughly copied/traced the writing in the hope that someone else would recognise it (8% [2 of 26]). Verbal drug orders: 54% [14 of 26] used verbal drug orders when on-call versus 31% [8 of 26] during normal days; when on-call 27% [7 of 26] stated they had never been asked. FY1s received verbal requests more frequently from different specialities (62% [16 of 26]) than from their own speciality (35% [9 of 26]). When taking verbal requests 62% [16 of 26] repeat back the prescription so it could be clarified. This survey suggests that FY1s faced with prescribing uncertainty generally adopt a range of safe mechanisms to minimise the risk of drug errors. These include using valid sources of information (colleagues, BNF) and for verbal orders using a “read back” technique. However some FY1s use “risky” behaviour not in keeping with GMC guidance/FY1 curriculum, particularly when rewriting illegible or unfamiliar drugs. This has the potential to lead to drug error. Further work is required to better understand these behaviours, but ways to reduce variability could include targeted education involving risk avoidance strategies and electronic prescribing with decision-support.
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