Rutkowski David, Keelan Ray, Warrander Lynne, Steinke Douglas
University Hospital of South Manchester, Wythenshawe, Manchester, UK.
Clin Teach. 2014 Oct;11(6):454-60. doi: 10.1111/tct.12204.
Reducing prescribing errors is key to ensuring patient safety. Foundation-year doctors (FYs) have been found to be major contributors to prescribing errors, and often feel poorly prepared for prescribing by their undergraduate education. Numerous studies have reported these findings; however, few studies have introduced meaningful interventions.
A questionnaire was sent to FY2s (n = 20) to determine the 15 most commonly prescribed medications on call. These medications and instructions were incorporated into a flashcard that was disseminated to new FY1s at a teaching hospital in the UK. The FY1s were asked to complete a pre- and post-flashcard questionnaire, giving instructions for 10 medications and their confidence in prescribing these medications. A control group at another teaching hospital were given the same questionnaires, but not the flashcard.
No significant difference in confidence was seen in FY1s at either hospital before the flashcard was issued. Both groups at week 4 demonstrated significant improvements in confidence in prescribing, with those who received the flashcard demonstrating a significantly higher level of confidence in a greater range of medications, compared with those who did not (p < 0.05). At week 4, 93 per cent of FY1s still used the flashcard 2.2 times per day, claiming that it saved time on call (9.2/10).
We have introduced an inexpensive and simple prescribing aid, which has been statistically shown to improve prescribing confidence in FY1s. Foundation-year doctors have been found to be major contributors to prescribing errors.
减少处方错误是确保患者安全的关键。已发现基础年医生（FYs）是处方错误的主要促成因素，并且他们常常觉得本科教育让他们在开处方方面准备不足。许多研究都报告了这些发现；然而，很少有研究引入有意义的干预措施。
向二年级基础年医生（n = 20）发放问卷，以确定值班时最常开具的15种药物。这些药物及其用法说明被制作成抽认卡，分发给英国一家教学医院的新入职一年级基础年医生。要求一年级基础年医生在收到抽认卡前后完成一份问卷，给出10种药物的用法说明以及他们对开具这些药物的信心程度。另一家教学医院的对照组收到相同的问卷，但没有收到抽认卡。
在发放抽认卡之前，两家医院的一年级基础年医生在信心方面均未显示出显著差异。在第4周时，两组在开具处方的信心方面均有显著提高，与未收到抽认卡的人相比，收到抽认卡的人在更多药物种类上表现出显著更高的信心水平（p < 0.05）。在第4周时，93%的一年级基础年医生每天仍使用抽认卡2.2次，称其节省了值班时间（9.2/10）。
我们引入了一种廉价且简单的处方辅助工具，经统计学证明它能提高一年级基础年医生开具处方的信心。已发现基础年医生是处方错误的主要促成因素。
