Safe And Practical Prescribing Training Provisions For Foundation Doctors: Trainer Perspective

MB KENNEDY1, I HAQ1, L BISSELL1, SE WILLIAMS2, M OKORIE1. 1Division of Medical Education, Brighton and Sussex Medical School, Brighton, East Sussex, UK, 2School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, East Sussex, UK

Introduction: Drug prescribing is a common healthcare activity but can potentially lead to patient harm. Up to 10% of hospital prescriptions contain a drug error (1); these are most commonly written by junior doctors, who often feel unprepared to undertake this task (2).

Aim: To determine the training provisions in safe and practical prescribing for Foundation doctors in NHS Trusts in the Kent, Surrey and Sussex region.

Methods: A web-based survey was designed using Bristol Online Surveys software. Prescribing Leads at NHS Trusts within Kent, Surrey and Sussex were invited to participate. The questionnaire was available from April to July 2014 and participation was voluntary. Microsoft Excel was used for analysis, using descriptive statistics.

Results: There were 10 respondents (representing 10 NHS Trusts) out of a total of 15 (67%). 9 NHS Trusts (90%) offered a separate induction programme for Foundation Year 1 (F1) and Foundation Year 2 (F2) doctors. Of the 9 NHS Trusts that offered safe prescribing training in their induction programme, only 5 (56%) included a practical prescribing session as part of this training, during which Foundation doctors gained practical experience in the correct use of the drug chart/ e-prescribing systems.

Taking the whole Foundation training year (including induction) into account, 6 NHS Trusts (60%) provided a dedicated practical prescribing session(s) to F1s whilst 2 NHS Trusts (20%) provided this to their F2s. 8 NHS Trusts (80%) provided dedicated session(s) on taking an accurate drug history to F1s, compared to 3 NHS Trusts (30%) for F2s. 8 NHS Trusts (80%) provided dedicated session(s) on pharmaceutical calculations to F1s, whilst 3 NHS Trusts (30%) provided this to F2s. F1s at 7 NHS Trusts (70%) received dedicated training on safety issues (i.e. reporting suspected or actual adverse drug reactions) but F2s at only 3 Trusts (30%) received the same training.

Conclusion: There are no agreed national or regional standards for the training of Foundation doctors in safe prescribing. Although most NHS Trusts provide safe prescribing training to foundation doctors, practical prescribing training is less than optimal. In addition, there is a lack of emphasis on F2 safe prescribing training, which corroborates the findings from a similar study looking at safe prescribing training provisions from a trainee perspective.

The UK Foundation Programme Curriculum 2012 (3) specifies a list of competencies that must be achieved by trainees, but each NHS Trust is responsible for developing processes by which the trainees meet these learning outcomes. There should be greater harmonisation in terms of safe prescribing training provisions, with a greater emphasis on F2 doctors.

References:

1. Dornan T et al. (2009). GMC: the EQUIP study [online].

2. Heaton A et al. (2008) Br J Clin Pharmacol 66(1): 128-134.

3. The Foundation Programme Curriculum 2012 [Online].