Improving feedback on junior doctors’ prescribing errors: mixed methods evaluation of a quality improvement project
| Autor: | Inderjit Sanghera, Ann Jacklin, Bryony Dean Franklin, Seetal Jheeta, Matthew Reynolds, Digby Ingle, Jonathan Benn |
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| Přispěvatelé: | Imperial College Healthcare NHS Trust, National Institute for Health Research (NIHR), The Health Foundation |
| Rok vydání: | 2016 |
| Předmět: |
Medical education
medicine.medical_specialty Quality management Formative Feedback Quality Improvement Report Control (management) education Psychological intervention Audit 030226 pharmacology & pharmacy Drug Prescriptions Medication safety 03 medical and health sciences 0302 clinical medicine Documentation IN-HOSPITAL INPATIENTS Nursing Intervention (counseling) Surveys and Questionnaires Audit and feedback REGRESSION medicine Medical Staff Hospital PROGRAM Humans Medication Errors 030212 general & internal medicine Practice Patterns Physicians' Quality improvement Science & Technology business.industry Health Policy Outcome measures SCIENCE CARE Focus group Health Care Sciences & Services Family medicine Health Policy & Services AUDIT business Life Sciences & Biomedicine |
| Zdroj: | BMJ Quality & Safety |
| Popis: | Background Prescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation. Aim To reduce prescribing errors in a UK hospital by improving feedback on prescribing errors. Interventions We developed three linked interventions using plan–do–study–act cycles: (1) name stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to provide feedback to doctors on individual prescribing errors and (3) fortnightly prescribing advice emails that addressed a common and/or serious error. Implementation and evaluation Interventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctors stated their name. Outcome measures were junior doctors' and pharmacists' perceptions of current feedback provision (evaluated using quantitative pre-questionnaires and post-questionnaires and qualitative focus groups) and the prevalence of erroneous medication orders written by junior doctors between August and December 2013. Results The percentage of medication orders for which junior doctors stated their name increased from about 10% to 50%. Questionnaire responses revealed a significant improvement in pharmacists' perceptions but no significant change for doctors. Focus group findings suggested increased doctor engagement with safe prescribing. Interrupted time series analysis showed no difference in weekly prescribing error rates between baseline and intervention periods, compared with the control site. Conclusion Findings suggest improved experiences around feedback. However, attempts to produce a measurable reduction in prescribing errors are likely to need a multifaceted approach of which feedback should form part. |
| Databáze: | OpenAIRE |
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