Pharmacy Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
Exeter Surgical Health Service Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
Br J Clin Pharmacol. 2019 Oct;85(10):2405-2413. doi: 10.1111/bcp.14065. Epub 2019 Aug 23.
To develop and evaluate a feasible, authentic pharmacist-led prescribing feedback intervention for doctors-in-training, to reduce prescribing errors.
This 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.
During 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.
Feedback 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.
开发并评估一种切实可行、真实可信的以药剂师为主导的针对受训医生的处方反馈干预措施，以减少处方错误。
这是一项混合方法研究。16 名接受培训的住院医师在英国 1 家医院的外科评估病房轮转，他们为 1 名患者采集用药史并开具处方，过程被拍摄下来。每位医生观看自己的录像并制定改进处方的计划，同时接受药剂师的反馈。在干预期间（2015 年 11 月至 2017 年 3 月），每周收集 1 天的定量数据（处方错误发生率数据），并对部分参与者进行个体半结构化访谈，以评估他们的经验。定量数据采用统计过程图进行分析，定性数据采用主题分析方法进行转录和分析。
在数据收集期间，药剂师共审查了 923 份患者药物图表，总共发现了 1219 项处方错误。实施这种反馈方法与处方错误数量的显著减少相关，从平均 19.0 个/天降至 11.7 个/天（估计减少 38%；P<.0001）。以药剂师为主导的视频刺激式处方反馈是可行的，受到参与者的积极欢迎，他们赞赏强化良好实践的机会，以及反思和改进实践的机会。
针对受训医生的反馈往往不够频繁，而且往往是负面的，但这种切实可行的反馈策略显著减少了处方错误，受到目标受众的欢迎，是一种支持性的发展方法。
