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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.

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Learning Safe Prescribing: How to Tackle?

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  1. Learning Safe Prescribing: How to Tackle? Samantha Murton and John Pearson General Practice Education Programme

  2. 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

  3. 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

  4. Methods • Focus groups with teachers • Questionnaire surveys of Registrars (71 completed) Teachers (85 completed) • Analysis of ‘Prescribing’ scaffold usage

  5. 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.

  6. 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

  7. 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

  8. 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%)

  9. 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

  10. 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

  11. Feedback to registrars Minimal other than phone calls from pharmacist

  12. 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

  13. So What • Development of teaching tools • Earlier delivery of prescribing seminar • Mechanism for feedback to registrars on outcomes

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