Benefit of targeted, pharmacist‐led education for junior doctors in reducing prescription writing errors – a controlled trial

Abstract

Background Prescribing errors are common and a known cause of adverse patient outcomes. Junior doctors are responsible for the majority of prescribing, and may benefit from educational interventions. Aim To assess the effect of (1) targeted pharmacist‐led feedback and education, and (2) an e‐learning prescribing module, on prescription writing error rates by junior doctors in the inpatient medical setting. Methods We undertook a cluster randomised trial in 2014 involving 16 prescribers in four general medical units of an Australian tertiary hospital. One unit was randomised to prescribing feedback and targeted education by a clinical pharmacist; another unit was randomised to an e‐learning intervention on safe prescribing; and two units were randomised to no intervention. Data were collected via daily audit of paper medication charts. A prescription writing error was deemed to have occurred if patient or prescriber details were incomplete, or if a medication order was illegible, incomplete or incorrect. Statistical analysis was by Chi‐squared comparison of each unit's error rate pre‐intervention to post‐intervention. Results Prescription writing errors were significantly reduced in the pharmacist education group, from 0.58 errors/total orders pre‐intervention to 0.37 errors/total orders post‐intervention (p < 0.001). Conversely, an increase in the error rate of the control group was observed from 0.49 to 0.59 errors/total orders (p < 0.001), and to a lesser extent in the e‐learning group from 0.58 to 0.63 errors/total orders (p = 0.025). Conclusions Regular and targeted pharmacist feedback and education is effective at reducing prescription writing errors, while the effect of e‐learning tools remains unclear.

Digital Learning to Improve Safe and Effective Prescribing: A Systematic Review

“…The database search yielded 2,110 records, 125 of which were eligible on the basis of title and abstract. Fifty‐nine full‐text articles were eligible for inclusion . Six additional articles were identified from the previously used database, making a total of 65 articles.…”

“…Table shows the characteristics of the digital teaching interventions. Most ( N = 55; 85%) articles described the use of (online) e‐learning, 11(20%) of which described e‐learning combined with traditional classroom teaching, making the intervention blended learning . Eight articles (15%) combined e‐learning with some sort of digital communication channel, such as Web forums or chatrooms for interaction with peers and teachers .…”

“…Nine articles (14%) described more unique learning interventions: gamified e‐learning, a text‐based virtual patient, an augmented reality virtual patient, e‐learning with email case discussions, a wiki‐like student drug formulary, a drug‐dosage simulator, a digital drug repository, and informative podcasts . Fifty‐one percent of interventions were aimed at postgraduate physicians, 25% were aimed at nonmedical prescribers (all of whom were nurses), 20% at medical students, and 11% at pharmacy students . Nine postgraduate courses (14%) were aimed at prescribers from more than one background; one was an undergraduate course (the Australian National Prescribing Curriculum) .…”

“…Ten articles (15%) had a descriptive design, 11 (17%) a qualitative design, and 44 (68%) a quantitative design . Twenty‐six of the quantitative articles (59%) used a randomized or nonrandomized trial design; the remaining 18 articles (41%) either used no control or compared one group before and after the intervention . The nature of the control group was diverse: five articles (11% of quantitative) compared the use of clinical practice guidelines to DLRs, and six (14%) compared traditional face‐to‐face teaching with e‐learning .…”

“…Articles directly comparing traditional teaching methods to DLRs reported equal effects in two, higher knowledge test scores after interventions with e‐learning in two, and a better performance on knowledge tests after a traditional lecture in one . One article reported a 5% increase of prescribing errors made by physicians after e‐learning, but a decrease from 58% to 37% after pharmacist‐led feedback and targeted education . The two articles comparing blended learning with nonblended DLRs found the intervention to be beneficial, but no relevant between‐group differences were found.…”