Pharmacist support and collaboration with junior doctors saw a reduction of dose errors from 54% down to 7%, according to a new study
Researchers from New Zealand have tested a new training model for intern or “junior” doctors in an effort to enhance opioid prescribing.
Doctors in their first year of practice, described as a “vulnerable” group of prescribers, were assessed pre-intervention for learning and dosing errors.
A pre-intervention audit showed that opioid prescribing by junior doctors was highly variable with an error rate as high as 74% and all four oxycodone prescriptions containing errors.
Dosing errors were the most significant, with 76% of them being incorrect selection of IV opioid dosing – two of which were potentially lethal, and three which were potentially harmful.
The full cohort of 81 junior doctors then underwent an intervention that involved completing an e-learning module on pain management and collaborative team teaching.
A select 52 participants that were rostered to surgery underwent further clinical supervision by an expert pharmacist at ward level.
These junior doctors were invited to review case studies of prescribing and “think like a pharmacist” so they could learn acceptable and non-acceptable prescribing (e.g. maximum dose over 24 hours, respiratory rate documentation and naloxone use) and how to recognise key safety features.
Study evaluation found there was a reduction of dose errors—from 54% pre-intervention to 7% post-intervention.
However there was no significant change in doctor knowledge of pharmacology and use of opioids.
This supports the findings of previous studies that prescribing errors are not linked to a lack of general pharmacology knowledge, said the authors in the Journal of Pharmacy Practice and Research.
All junior doctors that participated in the intervention reported an increase in confidence in prescribing opioids.
They attributed this to the program or a combination of the program alongside the experience gained on a surgical service.
The coaching by pharmacists was recognised and valued by all respondents at the end of placement evaluation.
Ward pharmacists (n = 4) reported a perceived enhanced relationship with the junior doctors.
“This program has highlighted the potential for further development of the medicine-pharmacy relationship as a true teaching and learning partnership,” say the authors from the University of Canterbury, the Waitemata District Health Board and Christchurch Hospital in New Zealand.
“The present intervention captured the naturally occurring interactions between medicine and pharmacy, and focused on making the world of prescribing and the hospital pharmacist more accessible to junior medical staff.”
Read the full study in the Journal of Pharmacy Practice and Research, the flagship journal of the SHPA