Developing junior doctors’ prescribing practices through collaborative practice: Sustaining and transforming the practice of communities

Abstract

Prescribing in acute healthcare settings is a complex interprofessional process with a high incidence of medication errors. Opportunities exist to improve prescribing learning through collaborative practice. This qualitative interview-based study aimed to investigate the development of junior doctors' prescribing capacity and how pharmacists contribute interprofessionally to this development and the prescribing practices of a medical community. The setting for this study was a large teaching hospital in Australia where ethical approval was gained before commencing the study. A constructionist approach was adopted and the interviews were held with a purposive sample of 34 participants including junior doctors (n = 11), clinical supervisors (medical; n = 10), and pharmacists (n = 13). Informed by workplace learning theory, interview data were thematically analysed. Three key themes related to pharmacists' contributions to prescribing practices emerged: building prescribing capacities of junior doctors through guidance and instruction; sustaining safe prescribing practices of the community in response to junior doctor rotations; and transforming prescribing practices of the community through workplace learning facilitation and team integration. These findings emphasize the important contributions made by pharmacists to building junior doctors' prescribing capacities that also assist in transforming the practices of that community. These findings suggest that rather than developing more conventional education programs for prescribing, further consideration should be given to interprofessional collaboration in everyday activities and interactions as a means to promote both effective learning for individuals and advancing the enactment of effective prescribing practice.

Opioids, the pharmacist and the junior doctor: reducing prescribing error

“…This worldview acknowledges that as we work, learn and practise together, we all learn and gain from each other, regardless of status or seniority. Noble et al . suggest that prescribing be theoretically framed as an activity occurring as part of the practice of a community.…”

“…In New Zealand, the consequences of prescribing errors are a major source of inadvertent harm for hospital patients, and the junior doctor workforce is a vulnerable group of prescribers . Prescribing is a complex task involving careful processing of clinical knowledge under pressure in the hospital environment, and junior doctors report that it is the most difficult aspect of their job, and the one for which they feel least prepared…”

“…Traditionally, post‐entry education and training of junior doctors has focused on providing an individual with competence and professional registration requirements, resulting in an individually‐focused approach . In contrast, work in healthcare systems is collective, collaborative and multidisciplinary by nature, suggesting that approaches to training and education that capture and build on the emerging practice of communities through the everyday activities of patient care could be more effective . Pharmacists play a key role in junior doctors’ informal learning on the ward as they discuss and clarify errant prescriptions, contribute advice and provide support.…”

“…In New Zealand, the consequences of prescribing errors are a major source of inadvertent harm for hospital patients, and the junior doctor workforce is a vulnerable group of prescribers. 1 Prescribing is a complex task involving careful processing of clinical knowledge under pressure in the hospital environment, 2 and junior doctors report that it is the most difficult aspect of their job, and the one for which they feel least prepared. 3 In the UK, concerns have been expressed about the prevalence of prescribing errors in the junior doctor population for over a decade, 4,5 yet little empirical work had been done to investigate the causes until the Errors -Questioning Undergraduate Impact on Prescribing (EQUIP) study in 2009.…”

“…11,12 In contrast, 2 work in healthcare systems is collective, collaborative and multidisciplinary by nature, suggesting that approaches to training and education that capture and build on the emerging practice of communities through the everyday activities of patient care could be more effective. 2 Pharmacists play a key role in junior doctors' informal learning on the ward as they discuss and clarify errant prescriptions, contribute advice and provide support. Pharmacists are continually educating all staff about new pharmaceutical products and prescribing processes: a role we observed, anecdotally, can go unnoticed, and therefore underutilised.…”