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

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

Introduction: Prescribing errors are a serious concern and compromise patient safety. They occur across all grades of doctors with the highest error rates being attributed to junior doctors, who are responsible for the majority of prescribing in our hospitals (1). It is concerning that new medical graduates are not adequately prepared to perform the complex task of prescribing, yet there are no agreed national or regional training standards in safe prescribing training to enable achievement of the desired outcomes (2, 3).

Aim: To determine the training provisions in safe prescribing available to Foundation Programme doctors in the NHS hospitals located in the South Thames Foundation School (STFS) region, in order to develop the most effective training strategies in safe prescribing.

Methods: A web-based questionnaire, containing open and closed questions was designed using the Bristol Online Surveys software. A link to the questionnaire was distributed by e-mail to Foundation Year 1 (F1) and Year 2 (F2) doctors in the STFS region. The questionnaire was available for completion from April to July 2014 and participation was voluntary. Results were transferred to Microsoft Excel for analysis to be performed. Descriptive statistics were used for the quantitative data, and thematic analysis for qualitative data.

Results: A total of 124 foundation trainees (7.2%) completed the online survey representing 16 NHS Hospital Trusts and included 69 F1s (55.6%) and 55 F2s (44.6%). Most of the F1s reported that they received dedicated training in safe prescribing at their NHS Trust induction (n=60, 87%) in comparison to less than half of the F2 doctors (n=27, 49%). 55 F1s (80%) had a practical prescribing session during induction, while the corresponding figure for the F2s was 15 (27%). By the end of the training period, which included induction, a total of 94% of F1s (n=65) and 56% of F2s (n=31) had received a dedicated training session in practical prescription writing (including drug chart workshops). Over twice as many F1s (n=42, 61%) as F2s (n=15; 27%) received dedicated training in pharmaceutical calculations during induction. At induction, almost three quarters of F1s had training on signposting to sources of information (n=50, 72%), whereas just over half of the F2s had the corresponding training (n=32, 58%). Towards the end of the foundation training year, over half of the F1 doctors felt much more confident in prescribing safely (n=38, 55%) compared with 29% of F2 doctors (n=16). Almost a quarter of F2s reported their confidence had not changed (n=13, 24%), in comparison with 3% of F1s (n=2).

Conclusion: There appears to be a lack of emphasis in the training of F2 doctors in safe prescribing compared with F1 doctors. This is despite the EQUIP study demonstrating that this group has the highest prescribing error rate (1). Further studies are necessary to explore the factors contributing to this with a view to optimising the training of F2 doctors in safe prescribing. Whilst the F1 training period seems to be positively impacting on confidence in safe prescribing there is scope for improvement and harmonisation of training across the region.

References:

1. Dornan T et al. (2009). GMC: The EQUIP study [Online]

2. Heaton A et al. (2008). Br J Clin Pharmacol 66(1):128-34

3. The Foundation Programme Curriculum 2012 [Online]