Antibiotic prescription errors: the relationship with clinical competence in junior medical residents.

Autor: Martínez-Domínguez J; Coordination of Educational Development and Curricular Innovation (CODEIC), National Autonomous University of Mexico (UNAM), Mexico City, México.; Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México., Sierra-Martínez O; Manuel Gea Gonzalez General Hospital, Mexico City, México., Galindo-Fraga A; Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México., Trejo-Mejía JA; Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México., Sánchez-Mendiola M; Coordination of Educational Development and Curricular Innovation (CODEIC), National Autonomous University of Mexico (UNAM), Mexico City, México., Ochoa-Hein E; Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México., Vázquez-Rivera M; National Institute of Pediatrics, Mexico City, México., Gutiérrez-Cirlos C; Internal Medicine, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México.; Internship and Social Service, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México., Naveja J; Chemistry Institute, National Autonomous University of Mexico (UNAM), Mexico City, México., Martínez-González A; Coordination of Educational Development and Curricular Innovation (CODEIC), National Autonomous University of Mexico (UNAM), Mexico City, México. adrianmartinez38@gmail.com.; Public Health Department, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, México. adrianmartinez38@gmail.com.; Consejos académicos, Circuito exterior, Ciudad Universitaria, C. P. 04510, Coyoacán, Ciudad de México, México. adrianmartinez38@gmail.com.
Jazyk: angličtina
Zdroj: BMC medical education [BMC Med Educ] 2022 Jun 14; Vol. 22 (1), pp. 456. Date of Electronic Publication: 2022 Jun 14.
DOI: 10.1186/s12909-022-03499-0
Abstrakt: Background: A large portion of prescribing errors can be attributed to deficiencies in medication knowledge. These errors are preventable and most often occur at the time of prescription. Antimicrobials are the drug class most common incorrectly prescribed.
Objective: To characterize the relationship between clinical competence and antibiotic prescription errors. We also investigated the frequency and severity of antibiotic prescription errors to identify items and attributes of clinical competence which are correlated with the antibiotic prescription error ratio.
Method: A cross-sectional study was applied to assess clinical competence of junior medical residents in two reference academic hospitals and a regional hospital in Mexico City. It was conducted during February 2019. We used an infectious disease Objective Structured Clinical Examination (OSCE) to assess clinical competence and a measure of frequency, and severity of antibiotic prescription errors.
Results: The number of eligible participants was ~ 255 (hospital meeting attendance), and the number of residents in this study were 51 (~ 20%), 31 were female (60.8%). The mean OSCE score was 0.692 ± 0.073. The inter-item (Cronbach's alpha = 0.927) and inter-station internal consistency was adequate (Cronbach's alpha = 0.774). The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The most frequent category of severity of antibiotic prescription errors was category E (errors that may contribute to or result in temporary harm to the patient and require intervention), 235 (65.2%). We observed a negative and significant correlation between clinical competence and antibiotic prescription errors (r = -0.33, p < 0.05, CI95% -0.57 to -0.07), which remained significant after controlling for the effect of gender and time since graduation from medical school (r = -0.39, p < 0.01, CI95% -0.625 to -0.118). Using exploratory factor analysis we identified two factors, which explained 69% of the variance in clinical competence, factor 1 evaluated socio-clinical skills and factor 2 evaluated diagnostic-therapeutic skills. Factor 2 was correlated with antibiotic prescription error ratio (r = -0.536, p < 0.001).
Conclusions: We observed a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of the clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent errors in antibiotic prescriptions would require a second intervention.
(© 2022. The Author(s).)
Databáze: MEDLINE
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