ePIFFany@Exeter

1 August 2016 - 31 March 2017

About the research

Video feedback to reduce junior doctor’s prescribing errors: a summary of a study undertaken in South West England

Project team

Karen Mattick (University of Exeter)
Odran Farrell (Royal, Devon and Exeter NHS Foundation Trust)
Hazel Parker (Royal, Devon and Exeter NHS Foundation Trust)
Ali Hodgetts (Royal, Devon and Exeter NHS Foundation Trust)
Rob Bethune (Royal, Devon and Exeter NHS Foundation Trust)

Background

Prescribing errors are common. Junior doctors are an important target group for interventions, since they may make more mistakes than senior doctors and write the most prescriptions in hospital settings.  Recent research highlights an important role for pharmacists in supporting junior doctors to improve their prescribing capabilities.  Performance feedback is likely to have significant educational impact and junior doctors report receiving insufficient feedback on prescribing currently.

What we did

We developed and implemented a simple, authentic and feasible prescribing feedback intervention for doctors-in-training.  Each doctor participant was filmed taking a medication history from a patient and, subsequently, when writing up a drug chart.  The doctor than reviewed the footage, supported by feedback from a pharmacist, and made plans to improve their prescribing.

What we found

Two thirds of junior doctors rotating through the general surgery ward of our district general hospital received feedback on their prescribing.  A statistically significant reduction in the mean number of pharmacist interventions (each equating to a prescribing error) was observed in the period after implementation.   Most prescribing errors would have had minimal risk of harm to patients but a small number of errors were more serious.  The feedback intervention was generally well received by junior doctors:  “It was really useful actually... we don’t often get a huge amount of feedback as F1s”. On reviewing the video footage, participants and pharmacists noted the dynamic and distracting locations chosen by junior doctors to prescribe medicines and complete documentation: “Probably the thing I think I learnt the most was watching how many times I got interrupted whilst prescribing.  A drug chart is what 10 minutes I think I got interrupted 12 times during the process”. After the study, many junior doctors used office space instead of the busy ward to undertake this task.

What we concluded

We concluded that everyone benefits from junior doctors receiving feedback on their prescribing practice – and that pharmacists are well placed to provide it.  The use of video footage facilitated reflection, for example on the environment in which prescriptions are written, and led to behaviour change.  Implementing this approach more widely would reduce prescription errors still further and improve support and development of junior doctors.

More information

Please contact Karen Mattick (k.l.mattick@exeter.ac.uk) or Odran Farrell (o.farrell@nhs.net) for more information about this project.  We would be happy to present or discuss the findings at appropriate fora.