Which skills do junior doctors require to prescribe safely?

Dr Effie DeardenStR General Medicine & Geriatric Medicine

Fellow in Medical Education

•What is the problem?l Prescribingl FY1sl Non-technical skills

•Literature Review results

•What next?l Direct observationl Interviews

Prescribing errors very common

FY1 FY2 Other Consultant

EQUIP (2009) 8.4% 10.3% 5.9%

PROTECT (2012) 7.0% 7.5% 7.6%

FY1/2 doctors wrote 68% of prescriptions in EQUIP

Dornan, T. et al., 2009. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study., London.Ross, S. et al., 2012. Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme. BMJ Quality & Safety, (October), pp.1–6.

Rate of prescribing errors

Why Non-Technical Skills?

Knowledge is easily accessible BNF More senior staff Pharmacy staff

Evidence of complex team and communication factors in error analysis

‘Despite the rhetoric about evidence-based medicine…FY1 doctors…learn prescribing by

prescribing in specific settings and within specific teams’

Kilminster, S., Zukas, M. & Roberts, T., 2006. Learning practice? Exploring the links between transitions and medical performance. Journal of Health Organization and Management, 24(6), pp.556–570.

Systematic Review

•Junior Doctors AND Prescribing–1,744 papers screened–14 included in final analysis

•No studies examining NTS in prescribing–Interpretative approach taken

•Papers coded using NVIVO into non-technical skills categories

Framework

Flin et al. Safety at the Sharp End: A guide to non-technical skills. Aldershot, Hampshire: Ashgate, 2008

Social Skills: Communication, Teamworking, Coping with Stress & Fatigue, Leadership

Cognitive Skills: Situational Awareness, Decision-making

Task Management

Communication & Team-Working

Patient as team-memberMerged due to overlap

'Send information clearly & concisely''Actively receive information’'Identify & utilise the skills of other team members''Speak up'

Situational Awareness

Limited experience = few mental models

'Awareness of own skills & limitations''Awareness of external & internal influences''Gathering, interpreting & checking information''Projection to future states'

Decision Making

Splitting of decisions

'Defining the problem''Deciding whether to prescribe''Applying norms, guidelines & protocols'

Task Management

Evidence of positive behaviours

'Being prepared & utilising resources''Prioritising tasks & patients''Maintaining standards'

Conclusion

LeadershipCoping with stress & fatigue

Limitations

Acknowledgements• Sheila Fisken & Ed Mellanby

Research Proposal

Direct observation• FY1/2 Doctors• Medical receiving unit• Field notes

Follow-up interviews• Recorded, transcibed & coded

Ethics waived by Scotland A REC

Questions?effie.dearden@ed.ac.uk