Training In Practical Prescribing And Medication Safety: A Survey Of Foundation Doctors

CIS Barker1, K Edwards2. 1Oxford University Clinical Academic Graduate School, Medical Sciences Division, John Radcliffe Hospital, Oxford, UK, 2John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK

Background: Teaching safe prescribing to junior doctors is critical to enhancing patient safety. In response to the results of an audit examining Time Critical Medicines (TCMs) prescription on our Surgical Emergency Unit, we surveyed Oxford Foundation trainees to gauge the level of medication training provided, experience of medication errors, and awareness of the National Patient Safety Agency (NPSA) TCMs campaign.

Aims: To establish the training exposure and experience of current trainees, with a view to improving training for future foundation doctors.

Methods: A cross-sectional web-based medication training survey was designed using the online tool “Survey Monkey”. The survey was emailed to the Oxford foundation trainees (193 in total). Survey completion was voluntary. The topics surveyed included: medical school; hours of training in prescribing and medication incidents; views on where extra training is needed; training/experience in: (a) paediatric prescribing (b) medication errors (c) incident forms; and TCM campaign awareness.

Results: 30 foundation doctors responded (16%), of whom 11 trained in the Oxford Medical School. Most trainees had received the majority of practical prescribing teaching at medical school; on average Oxford trainees reported receiving more teaching (>10 hours) than those from other medical schools (0-10 hours).

73% of respondents felt well-prepared to prescribe in their first foundation year. Areas identified where extra training would help included:

1) Intravenous and emergency drug prescription/administration

2) Patient-controlled analgesia and epidurals

3) Fluids

4) Anticoagulants and therapeutic drug monitoring

5) Paediatric prescribing

Regarding paediatric prescribing: 67% of respondents had been in paediatric posts, but only 43% reported receiving specific training in paediatric prescribing.

Most respondents had received only 1 hour of training in medication incidents, while 76% had encountered a medication error. The errors were most commonly detected by nurses (58%).

In only 3 cases were the errors thought to have caused harm. In the majority of cases, trainees thought the errors were dealt with justly. In several cases, helpful follow-up also occurred, including discussion/teaching with seniors, protocol review, or a serious untoward incident meeting.

Regarding incident forms, 59% had completed an incident form, but 48% did not know what happened afterwards. 26% were aware of receiving Trust medication incident updates. Relating to our audit, only 31% had heard of the TCM campaign; some from the NPSA website and others from teaching, the wards, or email alerts.

Conclusions: The survey results suggest that there is significant scope for improving the training on practical prescribing, medication incidents and TCMs. The implementation of the national prescribing assessment should promote junior doctors’ confidence and skills in prescribing. We hope that future surveys will show an improvement in foundation trainees’ experience and awareness of medication safety.

References:

1. NRLS-1183-Omitted and delayed medicines RRR-2010 02 23.

2. Barker CIS, Edwards K. The Prescription and Administration of Time Critical Medicines: an Audit of a Surgical Emergency Unit. BPS Winter Meeting, December 2011.