Teaching the principles of safe prescribing to a mixed profession postgraduate cohort: program development (original) (raw)

2018, Journal of Multidisciplinary Healthcare

Background: Prescribing medicines is a complex task. A robust prerequisite curriculum that enables the efficient and consistent training of safe and effective prescribers is important. Despite differing prescribing contexts and professional attributes, the core elements of safe and effective prescribing relevant to all prescribers can be identified. This article describes the development process and content of a training program for safe prescribing, which was designed for a mixed cohort of allied health professionals in Queensland, Australia. Methods: The allied health prescribing training program was designed to align with national standards for prescribing and competencies for safe prescribing. International training programs, for nonmedical prescribing, were examined to inform the program development. Content was delivered by experienced prescribers from a range of professions. The inaugural cohort was surveyed before and after training to ascertain their confidence to prescribe. Results: A training program for allied health prescribers was developed and delivered to enable the implementation of a state-sponsored research trial in Queensland public facilities. The program consisted of two modules (the second of which is described in this article) complemented by a mandatory period of supervised workplace learning. Remote blended learning, comprising online prerecorded lectures, self-directed learning, teleconference seminars, and a 2-day oncampus intensive residential, was used to deliver content. A total of 19 allied health professionals (12 physiotherapists and 7 pharmacists) completed the program that equipped them to begin a prescribing trial within their specific practice settings. Post module completion, 90% of the cohort felt confident to prescribe for patients in their practice area. Conclusion: Program development and delivery were challenging, requiring attention to both the needs of each profession and those of the individual practitioner who was required to apply generic prescribing principles to their specific practice setting. Further refinement of content, delivery, assessment, and resource allocation is required for future cohorts.

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Learning to prescribe - pharmacists' experiences of supplementary prescribing training in England

BMC medical education, 2008

The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP) courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice.

Teaching Prescribing: Just What the Doctor Ordered? A Thematic Analysis of the Views of Newly Qualified Doctors

Pharmacy

Undergraduate medical education has been criticised for failing to adequately prepare doctors for the task of prescribing. Pharmacists have been shown to improve medication use in hospitals. This study aims to elicit the views of intern doctors on the challenges of prescribing, and to suggest changes in education to enhance prescribing practice and potential role of the pharmacist. Semi-structured, qualitative interviews were conducted with intern doctors in their first year post qualification in an Irish hospital. Data collection was conducted until no new themes emerged and thematic analysis was performed. Thirteen interviews took place. Interns described training in practical prescribing as limited and felt the curriculum failed to convey the reality of actual prescribing. Pharmacists were perceived to be a useful, but underutilised, information source in the prescribing process. They requested an earlier introduction, and repeated exposure, to prescribing, and suggested the involvement of peers and pharmacists in this teaching. Intern doctors reported difficulties in applying knowledge gained in medical school to clinical practice. New strategies are needed to enhance the clinical relevance of the medical curriculum by rethinking the learning outcomes regarding prescribing practice and the involvement of pharmacists in prescribing education.

Effectiveness of a national approach to prescribing education for multiple disciplines

British Journal of Clinical Pharmacology, 2013

AimsTo evaluate the effectiveness of a national approach to prescribing education on health professional students’ prescribing and therapeutics knowledge, across multiple disciplines.MethodsIn a university examination setting, 83 medical, 40 pharmacy and 13 nurse practitioner students from three different universities completed a set of multiple choice questions (MCQs) before and after completing an online module from the National Prescribing Curriculum (NPC). To minimize overestimation of knowledge, students had to indicate the level of certainty for each answer on a three‐point scale. MCQs were scored using a validated certainty‐based marking scheme resulting in a composite score (maximum 30 and minimum −60). Students were asked to rate their perception of usefulness of the module.ResultsAt the pre‐module phase, there were no significant differences in the composite MCQ scores between the medical (9.0 ± 10.3), pharmacy (10.2 ± 10.6) and nurse practitioner (8.0 ± 10.7) students. Th...

Evaluation of effectiveness and relevance of Safe Medication Practice Tutorials as a course for pharmacist prescribers in New Zealand

Prescribing errors are associated with a significant risk of patient harm, and often caused by a lack of knowledge and skills on behalf of prescribers. The Safe Medication Practice Tutorials (SMPTs), which highlight error prone conditions and common errors within the healthcare system, were amended and presented in a one day workshop to experienced clinical pharmacists in New Zealand (n=14). Attendees were asked to provide feedback on the relevance of the tutorials as possible elements of a future course for pharmacist prescribing. There was an overwhelming agreement from attendees that all components of the course were relevant, with five sessions rated as essential; error awareness and prescribing safety; medication history taking; use of local medication charts and high risk scenarios; discharge prescribing; and feedback on errors. The SMPTs should be considered as a component of future non-medical prescribing courses to increase the awareness of prescribing errors and improve safe prescribing practices.

Developing and validating a tool for assessment of pharmacist prescribers' consultations

Family Practice, 2010

Objective To investigate the challenges experienced by pharmacists in delivering supplementary prescribing (SP) services, to explore their perceptions of benefits of SP and to obtain feedback on both SP training and implementation. Method A postal questionnaire focusing on prescribing training, early experiences of prescribing and general demographics was sent in September to November 2005 to all SP pharmacists (n = 488) in Great Britain after excluding a pilot sample (n = 30). The biggest benefits and challenges of SP, and reasons for not practising SP, were identified. Responses to a general open question were content analysed for major themes. Key findings A total of 401 responses (82.2%) was received; 195 (48.6%) had started practising SP of which 154 (79%) had written at least one prescription. This paper focuses primarily on perceived benefits and challenges to the implementation of SP, and the responses to the open question. Better patient management (n = 58; 29.7%) was identified as the main benefit of SP and inadequate funding (n = 27; 13.8%) as the biggest challenge in delivering SP service. The main reasons for not commencing SP were: no organisational recognition of SP (n = 37; 18%); lack of funding (n = 33; 16%); non-availability of prescription pads (n = 22; 10.7%), and change of jobs (n = 18; 8.7%). The comments to the open question (n = 145; 36.2%) were regarding: SP training; perceived benefits of SP; and barriers to SP. Respondents highlighted the need for greater emphasis on clinical skills development as part of the SP course. Conclusion Despite optimism among SP pharmacists, the need for support in terms of infrastructure and integration into the healthcare team has been identified. Our findings also inform the need for modifications in the structure, content and delivery of the prescribing course for pharmacists. Greater publicity of pharmacists' roles in medication management, support from the medical profession and healthcare organisations, and high standards by early practitioners are warranted for the success of SP by pharmacists.

Junior doctors prescribing: enhancing their learning in practice

Methods Multiple methods study including face-to-face and telephone interviews, questionnaires, and secondary data from a safe prescribing assessment (n=284). Three medical schools with differing curricula and cohorts: Newcastle (systemsbased, integrated curriculum); Warwick (graduate entry) and Glasgow (problembased learning (PBL)), with graduates entering F1 in their local deanery. The primary sample consisted of final year medical students, stratified by academic quartile (n=65) from each of the three UK medical schools. In addition an anonymous cohort questionnaire was distributed at each site (n=480), triangulating interviews were conducted with 92 clinicians and questionnaire data was collected from 80 clinicians who had worked with F1s. Results Data from the primary sample and cohort data highlighted that graduates entering F1 felt under-prepared for prescribing. However there was improvement over the F1 year through practical experience and support. Triangulating data reinforced the primary sample findings. Participants reported that learning in an applied setting would be helpful and increase confidence in prescribing. No clear differences were found in preparedness to prescribe between graduates of the three medical schools. Conclusion The results form part of a larger study 'Are medical graduates fully prepared for practice?' Prescribing was found to be the weakest area of practice in all sources of data. There is a need for more applied learning to develop skill-based, applied aspects of prescribing which would help to improve preparedness for prescribing.

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