Can targeted feedback on junior doctors’ prescribing reduce prescribing errors on discharge?

Adel Sheikh is the lead pharmacist for Antimicrobials and Respiratory at Portsmouth Hospitals NHS Trust. He qualified in the year 2000 after completing his pre-registration year at University Bristol Hospitals Trust. He then worked in Southampton General Hospital for three years as a rotational pharmacist before moving to become a Prescribing Support Pharmacist in Southampton PCT. In 2004, he moved to Portsmouth Hospitals into his current role. In 2007 he registered as an independent prescriber. He is also a pre-registration tutor.

Adel is one of the education leads for the UKCPA Pharmacy infection Network (PIN) committee.

He enjoys playing golf, tennis and watching all kinds of sports.

Dr Kayode Adeniji graduated from the Royal London Medical College in 1999. Following completion of his specialist training he undertook a Critical Care fellowship at the University of Toronto, before his appointment as Consultant in Respiratory and Intensive Care Medicine at Queen Alexandra Hospital in the UK in 2012. His clinical and research interests are in the fields Critical Care Outreach, early rehabilitation following critical illness and the Post Critical illness follow-up clinic. This dovetails with his role as Cardio-pulmonary Exercise Testing lead at Portsmouth NHS Trust and lead of the Respiratory Failure Service (Non-Invasive Ventilation service) in the Respiratory Department.

Michael Curtis is the Lead Pharmacist for Women and Children at St Richard’s Hospital, part of Western Sussex Hospitals Trust. Since graduating from Portsmouth University in 2008 he has worked in a number of hospitals across the UK as a rotational pharmacist including Singleton Hospital, Swansea and Queen Alexandra Hospital, Portsmouth; completing his postgraduate diploma in clinical pharmacy from Brighton University in 2014.

Medication issues place a substantial burden on both the National Health Service (NHS) and its patients. NHS England estimate 5–8% of all unplanned hospital admissions are due to medication issues¹ and a National Patient Safety Agency (NPSA) report estimated the cost of preventable harm due to medication at £750 million per year.²

Discharge back to primary care from an episode of secondary care represents a key point where medication errors can occur due to the potential breakdown of medication changes being appropriately communicated back to primary care.

A Health Network report (Improving patient safety through providing feedback to junior doctors on their prescribing errors: the Prescribing Improvement Model) demonstrated a small but significant improvement in junior doctors prescribing following a sustained intervention in the form of verbal feedback and regular ‘prescribing tips’ emails.³

To investigate any effect on the quantity of discharge prescriptions with at least one prescribing error following the provision of individualised monthly feedback on prescribing errors to a cohort of junior doctors and their education supervisors.

During the investigation the discharge prescriptions of two cohorts of junior doctors (Aug15–Nov15 and Dec15–Mar 16) were closely monitored. Each discharge prescription ‘screened’ by pharmacy from the respiratory wards during weekday pharmacy opening was included. Following ‘screening’ in line with trust policy it was recorded whether a discharge prescription contained an error or not and the ‘type’ of error. Each month the total number of discharge prescriptions with and without errors were recorded for each junior doctor.

Each month this data was confidentially fed back to both the junior doctor and their education supervisor with an offer to have a discussion with the ward pharmacist regarding the fine detail of their individual data to facilitate any teaching points and address any concerns.

Cohort 1 (Aug15–Nov15): mean prescriptions 12.2 (SD 7.5) each with an error rate reduction from 70% to 34% (mean 39.3% (SD 28.7), p=0.0006, 95% CI ±18).

Cohort 2 (Dec15–Mar16): mean prescriptions 10.8 (SD 7.3) each with an error rate reduction from 54% to 20% (mean 33.6% (SD 21.9), p=0.0002, 95% CI ±13.9).

These results demonstrate a statistically significant benefit of the intervention that was independent of the introduction of the information technological intervention in September 2015

(ICE TTOs).

Providing individual feedback to doctors and their education supervisors on current prescribing error rate and type of error significantly reduced the quantity of prescribing errors at discharge.

1. Frontier Economics. Exploring the costs of unsafe care in the NHS. London: Frontier Economics Europe; 2014
2. National Patient Safety Agency 2007. Safety in doses – improving the use of medicines in the NHS. www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61626&type=f.
3. Imperial Collage Healthcare NHS Trust. Shine 2012 final report: Improving patient safety through providing feedback to junior doctors on their prescribing errors: the Prescribing Improvement Model. London: The Health Foundation; 2014.