Transcript Learning Safe Prescribing: How to Tackle?

Learning Safe Prescribing:
How to Tackle?
Samantha Murton and John Pearson
General Practice Education Programme
The L Plate Prescriber in General Practice
Very little is known about specific learning
needs of GP Registrars in relation to quality
use of medicine or the difficulties they
experience when learning to prescribe
The L Plate prescriber in general practice: Learning needs of GP
Registrars and barriers to the quality use of medicine
Cooling, Bunker, and Ajjawi. GPET Annual Conference 2010
GMC EQUIP* Study
• 124,260 prescriptions, 19 hospitals, 7 days
• 11077 contained errors (8.9%)
•
•
•
•
8.4% Year 1 doctors
10.3% Year 2 doctors
8.3% Fixed term Specialty posts
5.9% Consultants
• 1.7% potentially lethal
* Errors-Questioning Undergraduate Impact on Prescribing GMC 2009
Methods
• Focus groups with teachers
• Questionnaire surveys of
Registrars (71 completed)
Teachers (85 completed)
• Analysis of ‘Prescribing’ scaffold usage
Results – Prescribing Resources
•
•
•
•
•
•
Mims and Mims online (through MedTech)
bpac guides (website and news letters)
British National Formulary
Medsafe materials
Pharmac/Pharmaceutical schedule
Royal Melbourne
• Safe foetus, Christchurch DHB pink book, Best Practice,
practice protocols, other colleagues, prescriber updates,
local antibiotic guidelines, Clinical Knowledge summaries,
Health Pathways, prescribing in pregnancy.
Issues for Registrars
•
•
•
•
•
•
•
•
•
Medtech
Dosing
Special authority numbers
Names of drugs funded
Patient preferences
Interactions
Polypharmacy
Starting medications in uncontrolled environment
Generic versus brand names
Issues for teachers
•
•
•
•
•
•
•
Knowledge base
Hospital orientated prescribing
Dosage
Interactions
Overcautious scripts
Lack of awareness of Pharmac, special authority
Lack of knowledge of treatment of problems only
seen in general practice
• Costs of medications
Scaffold Activities
• Registrars found them useful and wanted
more information on MedTech usage
• Drug interactions, prescribing in
pregnancy
• Teachers hadn’t used scaffold (60%);
those that had found it useful to very
useful (90%)
Teaching on Prescribing
• Registrars with GP Teacher (46%)
• Mainly case by case, specific teaching on
subjects, specific instruction on certain
drugs
• Many registrars indicated minimal
teaching or hospital teaching as JMO
Teaching Activities
Mainly case discussion/review (60%)
Specific activities
• Weekly look at prescribing case by case
• Specific training - virtual patient to generate
scripts
• Topic based – contraception, opiates, antibiotics,
allergy, dementia, acne…
• Reviewing patients with chronic illnesses
Feedback to registrars
Minimal other than phone calls from
pharmacist
Numbers of errors/omissions per
fortnight
• Not a big problem?
• Both teachers (55%, 9% more) and
registrars (67%, 16% more) indicated that
they might be contacted 1-3 times per
fortnight concerning a script
So What
• Development of teaching tools
• Earlier delivery of prescribing seminar
• Mechanism for feedback to registrars on
outcomes