#NPPG2016 Keynote address elearning to improve paediatric prescribing competence Sarah Pontefract, SCRIPT Editorial Lead & Sam Lissauer, Clinical Research Fellow, University of Birmingham
SCRIPT Paediatric elearning to improve paediatric prescribing competence Dr Sam Lissauer Miss Sarah Pontefract
Background There is a consistent theme of under-preparedness for prescribing Foundation trainee doctors. [1] The GMC commissioned EQUIP study [2] recommended: Education in practical prescribing should be part of early postgraduate training. Foundation trainee doctors should be given explicit feedback regarding their prescribing practice. [2] Education in prescribing should be a continuing process in postgraduate medicine. [3] @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Aim Encourage safe, effective, and rational prescribing by developing elearning modules that reflect current prescribing practice in the NHS. Standardise prescribing education for Foundation trainee doctors and encourage self-directed just-in-time learning relating to prescribing and therapeutics. Facilitate monitoring of trainees progress through their learning and monitor knowledge acquisition. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Undergraduate access: 11 medical schools 2010 2012 2013 2014 2015 2016 Foundation Doctors Foundation Dentists 47 modules Paediatric Trainee Doctors 7 modules Nursing 25 modules GPs 18 modules 20 modules 2017 launch
Dr Sam Lissauer Paediatric Trainee University of Birmingham @NHS_HealthEdEng
Trainees and prescribing
Medication Errors 33,000 paediatric safety incidents were reported to the NRLS in 2008. Medication errors accounted for 20% of these. The incidence of prescribing errors in paediatric in-patients is around 13%. RCPCH need for a response to critical incidents of gross prescribing error affecting children. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Medication Errors A West Midland survey 90% of specialist paediatric trainees had been involved in a prescribing error. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
RCPCH Curriculum (2016) Good Clinical Care This section describes the generic competencies (knowledge, skills and behaviour) that relate to clinical practice and the importance of the child s needs e.g. APLS, history taking, clinical examination (assessment standards 2-8), promotion of patient safety and therapeutics and prescribing (standards 9-12) and safeguarding children (assessment standard 13).
RCPCH Curriculum (2015) Level One Level Two Level Three Knowledge and skills in safe prescribing of common drugs in paediatrics Improving safe prescribing in paediatrics and in advising others appropriately Responsibility for safe prescribing in common and complex situations and for the supervision of others @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
START Specialty trainee assessment of readiness for tenure. Assessment taken in ST7. There is a high incidence of developmental needs on prescribing station nationwide, for example: Intravenous aminophylline. Dose adjustment of gentamicin in renal impairment. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Our Vision Provide an elearning programme to improve the prescribing knowledge and skills of ST1 ST8 trainees and non-medical prescribers within paediatrics. Create content for 25 paediatric specific modules. Create a learning environment that will encourage learning and reflective practice. Provide evidence for continuing professional development and linkage to paediatric specific curriculum and e-portfolio. Provide a team of clinical pharmacologists, pharmacists, paediatricians and elearning experts to design, develop and disseminate the results of this elearning programme. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Lets hear more @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
The Paediatric SCRIPT modules and how they fit into training @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
@NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Sarah Pontefract SCRIPT Editorial Lead University of Birmingham @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
The elearning Programme Web-based learning Clear learning outcomes Prescribing and therapeutics Background pharmacological knowledge Scenario-based learning Patient safety Pre-test to identify learning needs; post-test to assess knowledge acquisition In-module formative assessment to embed knowledge Certification e-portfolio
Monitoring Progress Dedicated reporting tools. Access to When modules are completed. Pre- and post-test scores. Time spent on the learning. Why? Ensure that trainees are taking steps to develop their prescribing knowledge in postgraduate education. Support feedback for trainees about their prescribing education. Encourage discussion about prescribing in workplace education and during appraisals. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Evaluation Results Behaviour Learning Reaction Figure adapted from Kirkpatrick s (1998) model of training evaluation @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Evaluation Results Behaviour Learning Reaction 75% of respondents agreed it had a positive impact on prescribing skills and knowledge 66% felt more able to challenge decisions 75% had changed prescribing practice
Integration into Training
Quality Assurance Authored by specialists healthcare professionals Physician; Pharmacist; Nurse. Modules are externally peer reviewed. All modules are reviewed by the author every 2 3 years. Content updated on a daily basis as new guidance is published or patient safety alerts are disseminated. The editorial and technical team respond to feedback from users everyday. @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Quality Assurance Feedback link @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
Any Questions? Email script@bham.ac.uk @NHS_HealthEdEng @PaedSCRIPT #safeprescriber
With thanks to Specialist Editorial Board Helen Goodyear Fiona Reynolds Eleanor Hay Liz Evans Rhian Isaac Akila Ahmed Maybelle Wallace Our authors and peer reviewers Health Education England School of Paediatrics Specialist Paediatric Editorial Board University of Birmingham SCRIPT Editorial team OCB Media Ltd Birmingham Children s Hospital
References 1. Rothwell, C., Burford, B., Morrison, J., et al. (2012) Junior doctors prescribing: enhancing their learning in practice. British Journal of Clinical Pharmacology, 73 (2): 194-202. 2. Dornan, T., Ashcroft, D., Heathfield, H., et al. (2009) An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. [online]. http://www.gmcuk.org/about/research/research_commissioned_4.asp 3. Ghaleb MA, Barber N, Franklin BD, Wong ICK. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Archives of Disease in Childhood. 2010;95(2):113-8.