Smith Samantha E, Tallentire Victoria R, Cameron Helen S, Wood S Morwenna
University of Edinburgh, Edinburgh, UK.
Clin Teach. 2012 Feb;9(1):45-9. doi: 10.1111/j.1743-498X.2011.00506.x.
The General Medical Council mandates that UK medical graduates must be able to 'prescribe drugs safely, effectively and economically'. However, data from three UK medical schools show that graduates are poorly prepared for prescribing, and a recent study detected a prescribing error rate of 8.4 per cent amongst foundation year 1 doctors.
This study took place in the National Health Service (NHS) Fife where, in common with all health boards in the UK, medical students are not permitted to prescribe. University of Edinburgh final-year medical student volunteers took part in the study.
Medical, pharmacy and nursing staff collaborated to design and implement a controlled process (pre-prescribing) that allows medical students to write instructions on in-patient drug charts, and requires a doctor's countersignature before drugs are dispensed. Key features of the pre-prescribing protocol include fluorescent stickers for drug charts, bookmark aide-memoires to guide countersigning and ward-based information sheets. Twelve final-year medical students wrote 586 pre-prescriptions, and no adverse events were reported.
This study demonstrates the successful small-scale implementation of pre-prescribing. Initial data regarding the safety of the process is positive, but further evaluation is required to reassure all that the risk of adverse events is minimal. The project is to be expanded throughout South East Scotland with a view to all units providing the opportunity for pre-prescribing during the first student assistantships in March 2012. The longer-term goal is to set-up safe processes that will support medical students undertaking pre-prescribing throughout most of their final year.
英国医学总会规定，英国医学毕业生必须能够“安全、有效且经济地开药”。然而，来自英国三所医学院的数据显示，毕业生在开药方面准备不足，并且最近一项研究发现，一年级住院医生的开药错误率为8.4%。
本研究在法夫郡国民保健服务体系（NHS）开展，与英国所有卫生委员会一样，医学生在此不被允许开药。爱丁堡大学医学专业最后一年的学生志愿者参与了这项研究。
医学、药学和护理人员合作设计并实施了一个可控流程（预开药），该流程允许医学生在住院患者的药物图表上书写医嘱，并且在配药前需要医生会签。预开药方案的关键特征包括药物图表上的荧光贴纸、用于指导会签的书签式辅助记忆工具以及病房信息单。12名医学专业最后一年的学生书写了586份预开药方，且未报告不良事件。
本研究证明了预开药在小规模实施方面取得了成功。关于该流程安全性的初步数据是积极的，但需要进一步评估以确保所有人相信不良事件的风险极小。该项目将在苏格兰东南部扩大，以期所有单位在2012年3月的第一批学生实习期间提供预开药机会。长期目标是建立安全流程，以支持医学生在最后一年的大部分时间里进行预开药。
