Pharmacist‐led, video‐stimulated feedback to reduce prescribing errors in doctors‐in‐training: A mixed methods evaluation

Abstract

AimsTo develop and evaluate a feasible, authentic pharmacist‐led prescribing feedback intervention for doctors‐in‐training, to reduce prescribing errors.MethodsThis was a mixed methods study. Sixteen postgraduate doctors‐in training, rotating though the surgical assessment unit of 1 UK hospital, were filmed taking a medication history with a patient and prescribing medications. Each doctor reviewed their video footage and made plans to improve their prescribing, supported by feedback from a pharmacist. Quantitative data in the form of prescribing error prevalence data were collected on 1 day per week before, during and after the intervention period (between November 2015 and March 2017). Qualitative data in the form of individual semi‐structured interviews were collected with a subset of participants, to evaluate their experience. Quantitative data were analysed using a statistical process chart and qualitative data were transcribed and analysed thematically.ResultsDuring the data collection period, 923 patient drug charts were reviewed by pharmacists who identified 1219 prescribing errors overall. Implementation of this feedback approach was associated with a statistically significant reduction in the mean number of prescribing errors, from 19.0/d to 11.7/d (estimated to equate to 38% reduction; P < .0001). Pharmacist‐led video‐stimulated prescribing feedback was feasible and positively received by participants, who appreciated the reinforcement of good practice as well as the opportunity to reflect on and improve practice.ConclusionsFeedback to doctors‐in‐training tends to be infrequent and often negative, but this feasible feedback strategy significantly reduced prescribing errors and was well received by the target audience as a supportive developmental approach.

Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video‐enhanced feedback and deliberate practice

“…The effect of video in facilitating feedback and deliberate practice, 59 however, has been found to be particularly important for learning gains in a variety of contexts 30 . In healthcare, two studies have successfully demonstrated the adoption of video‐based feedback; first, to improve surgical technical skills 60 and, second, to reduce prescribing errors 46 . These two interventions involved filming practice in situ.…”

“…In another study involving a pharmacist-led video-stimulated feedback intervention, researchers also observed a reduction in prescribing errors among participants, albeit there was no control group to fully assess the real effect of the intervention. 46 The aim of this research was to investigate the effectiveness of simulated clinical encounters using personalised, structured, videoenhanced feedback and deliberate practice for improving the prescribing and patient safety behaviour of Foundation Year doctors.…”

“…30 In healthcare, two studies have successfully demonstrated the adoption of video-based feedback; first, to improve surgical technical skills 60 and, second, to reduce prescribing errors. 46 given to improving everyday skills such as prescribing, safe handover, 61 acting on results 62 and undertaking ward rounds. 63 The observed error rates calculated from individual's daily prescribing data, collected in Study 2 and 3, are notably greater than the group-level error rates reported in the most cited previous study.…”

“…A study involving novices 45 identified that video‐enhanced feedback improved clinical skills performance over and above the effect of receiving feedback on skills development directly from an expert. In another study involving a pharmacist‐led video‐stimulated feedback intervention, researchers also observed a reduction in prescribing errors among participants, albeit there was no control group to fully assess the real effect of the intervention 46 …”

Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing

“…The challenge now for educators is to develop ways for mainstreaming the delivery of SRL-enhanced video feedback post-simulated clinical encounters for complex cognitive tasks such as prescribing. For simple skill-based tasks, the benefits of using video feedback are well-established (Farquharson et al 2013;Hachambachari et al 2017;Naik et al 2018;Parker et al 2019). In some cases, there is evidence that improvements in clinical skills development using video are equally effective (Phillips et al 2017) if not more effective (Nesbitt et al 2015) in comparison to feedback received directly from an expert.…”