Improving junior doctor medicine prescribing and patient safety: an intervention using personalised, structured, video?enhanced feedback and deliberate practice

Green, William; Shahzad, Muhammad Waseem; Wood, Stephen; Martinez Martinez, Maria; Baines, Andrew; Navid, Ahmad; Jay, Robert; Whysall, Zara; Sandars, John; Patel, Rakesh

Abstract

Aims

This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video?enhanced feedback and deliberate practice, undertaken at the start of four?month sub?specialty rotations.

Methods

Three prospective, non?randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break?even analysis evaluated cost?effectiveness.

Results

There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI ?0.068 to ?0.001). The break?even analysis demonstrates cost?effectiveness for the intervention.

Conclusion

Simulated clinical encounters using personalised, structured, video?enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost?effective with potential to reduce avoidable harm.

• Journal Article Type: Article
• Acceptance Date: Mar 26, 2020
• Online Publication Date: Apr 28, 2020
• Publication Date: 2020-11
• Deposit Date: May 18, 2020
• Publicly Available Date: May 19, 2020
• Journal: British Journal of Clinical Pharmacology
• Print ISSN: 0306-5251
• Electronic ISSN: 1365-2125
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 86
• Issue: 11
• Pages: 2234-2246
• DOI: https://doi.org/10.1111/bcp.14325
• Keywords: Pharmacology (medical); Pharmacology
• Public URL: https://nottingham-repository.worktribe.com/output/4464810
• Publisher URL: https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.14325