Social Sciences
ePIFFany@Exeter
1 August 2016 - 31 March 2017
PI/s in Exeter: Professor Karen Mattick
Sponsor(s): South West Academic Health Science Network (SWAHSN) & Pfizer Ltd
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.