Dataset Information

Improving acute medical management: Junior Doctor Emergency Prescription Cards.

ABSTRACT: Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97.7%). The EPCs support the management of unwell patients, are relevant to the workload of modern doctors practice and may improve patient care. This improvement measure could be applied to other NHS trusts and medical specialties.

SUBMITTER: Hutton J

PROVIDER: S-EPMC4822022 | biostudies-other | 2016

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description:BackgroundA 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.ObjectiveTo 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.MethodA 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.ResultsThe 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).ConclusionsWe 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.

Project description:ObjectivesTo investigate the hypothesis that junior doctors' examination skills are deteriorating by assessing the medical admission note examination record.DesignRetrospective study of the admission record.SettingTertiary care hospital.MethodsThe admission records of 266 patients admitted to Wellington hospital between 1975 and 2011 were analysed, according to the total number of physical examination observations (PEOtot), examination of the relevant system pertaining to the presenting complaint (RelSystem) and the number of body systems examined (Nsystems). Subgroup analysis proceeded according to admission year, level of experience of the admitting doctor (registrar, house surgeon (HS) and trainee intern (TI)) and medical versus surgical admission notes. Further analysis investigated the trend over time in documentation with respect to cardiac murmurs, palpable liver, palpable spleen, carotid bruit, heart rate, funduscopy and apex beat location and character.ResultsPEOtot declined by 34% from 1975 to 2011. Surgical admission notes had 21% fewer observations than medical notes. RelSystem occurred in 94% of admissions, with no decline over time. Medical notes documented this more frequently than surgical notes (98% and 86%, respectively). There were no differences between registrars and HS, except for the 2010s subgroup (97% and 65%, respectively). Nsystems declined over the study period. Medical admission notes documented more body systems than surgical notes. There were no differences between registrars, HSs and TIs. Fewer examinations were performed for palpable liver, palpable spleen, cardiac murmur and apex beat location and character over the study period. There was no temporal change in the positive findings of these observations or heart rate rounding.ConclusionsThere has been a decline in the admission record at Wellington hospital between 1975 and 2011, implying a deterioration in local doctors' physical examination skills. Measures to counter this trend are discussed.

Dataset Information

Improving acute medical management: Junior Doctor Emergency Prescription Cards.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets