Safer Medicines: The use of simulation to improve awareness of prescribing errors

(Data from a pilot project)

O Mukhtar, RL Brum, S Ratnarajah, M Currie, SH Jackson, S Broughton. King's College Hospital, London, UK

INTRODUCTION: In recent years there has been an exponential increase in the use of medical simulation. The advantages of this approach include immersive, experiential, on-demand learning, with ‘real-time’ feedback in a safe, risk-free environment. However, the utilisation of this approach to applied pharmacology has been limited, despite the fact that safe prescribing remains a challenge - in 2009, the GMC reported a mean error rate of 8.9 errors per 100 medication orders amongst foundation trainees.

METHODS: In keeping with a learner centred, andragogical approach, informal guidance was sought from potential participants (FY trainees & nursing staff) and stakeholders (Foundation School, Pharmacy and Postgraduate Centre). ‘SMART’ learning objectives were developed in keeping with Bloom’s hierarchy, extending from a recall of information to the evaluation of prior prescribing.

A series of five, fully immersive, multi-professional simulations were devised. These aimed to highlight learning from: 1) ‘real-life’ scenarios in which hazardous prescribing had occurred (based upon Incident Reports and Serious Untoward Events at King’s College Hospital), 2) recent safety warnings/messages for medicines issued by the MHRA, National Patient Safety Agency or NHS Commissioning Board and 3) ethical issues arising from prescribing errors. A detailed session plan incorporating visual, auditory, reading and kinaesthetic approaches to adult learning (Vygotsky, 1978) was composed and potential participants – capped at five foundation trainees and five nurses - were canvassed by a series of emails and posters. The project was supported by a BPS Teaching Grant.

RESULTS: Whilst the simulation day was oversubscribed, on the day of the simulation, four Practice Development Nurses and 1 FY1 failed to attend. The remaining candidates consisted of three FY1s, one FY2 and one cardiothoracic nurse practitioner.

Using a five point Likert scale, all five trainees ‘strongly agreed’ with the statement; ‘I have learnt important concepts for patient safety’. Four of the five trainees ‘strongly agreed’ with ‘I know more about sources of prescribing information’; the fifth trainee ‘agreed’ with this statement. When offered the opportunity to specify which technical and non-technical skills had been gained, free text comments included: “knowing about MHRA sign up and NPSA website as good sources of info” and “learning about drug interactions, prescribing according to weight…”. When asked to comment on how the session might be improved, two trainees suggested that the presence of more MDT members would be useful; a third commented that they would like “a hand-out with information on common prescribing errors”.

DISCUSSION: Whilst the sample size in this pilot was small, we have demonstrated the acceptability of simulation as a means of highlighting recurrent prescribing errors and sources of prescribing information. With further sessions proposed, we believe that simulation may be a useful adjunct in improving prescribing skills.