Safe Prescribing & SCRIPT Katie Reygate Prescribing Lead, HEKSS Pharmacy Education Safe Prescribing Agenda • A quarter of litigation claims in the NHS stem from medication errors. • Medical School Council Safe Prescribing Working Group (2007) • GMC UK preparedness report (2008) – Perceived weakness in prescribing • EQUIP study 2009: – 8.4% F1’s, 10.3% F2’s, 8.9% Overall – Pharmacists safety-net – 21 Recommendations • Prescribing Skills Assessment – Online Pilot 2013 – All Medical Schools 2014 Safe Prescribing Agenda • • • • HE KSS Foundation Doctor Prescribing Assessment SCRIPT to support prescribers in the workplace Leadership for prescribing Communication of advice and training for practising prescribers • Initial training of prescribers, specifically Non-medical prescribers Safe Prescribing Project Board SCRIPT • Standard Computerised Revalidation Instrument for Prescribing and Therapeutics • Purpose: – Improve the prescribing knowledge and skills of newly qualified doctors during the formative years of their professional development, in order to reduce medication errors and improve patient safety. – Encourage safe, effective, and rational prescribing by developing learning modules that reflect current prescribing practice in the NHS. SCRIPT Content • SCRIPT contains 41 modules across a wide range of crucial therapeutic areas: • Each module is authored, and subsequently peer reviewed, by specialist healthcare professionals. Unit Modules Unit Modules The Principles of Prescribing • • • • • • • • Prescription Documentation Fundamentals of Pharmacology Taking a Safe and Effective Drug History Adherence and Concordance Clinical Kinetics Dosing and Calculation Formulation and Administration Prescribing in Infection Therapeutic Groups • • • • • • • • • Prescribing in Medical Emergencies • • • • Drug Allergy and Anaphylaxis Poisoning Cardiac Arrest Fluids Clinical Governance Managing the Risks of Prescribing • • • • • • Adverse Drug Reactions Medication Errors Monitoring Drug Therapy Drug Interactions Toxic Tablets Parenteral Poisons Advanced Prescribing Prescribing in Special Circumstances • • • • Perioperative Prescribing Prescribing in Hepatic Dysfunction Prescribing in Renal Dysfunction Prescribing in Older Adults • • • • Respiratory Medicine Diabetes Psychiatric Symptom Management in General Hospital Settings Anticoagulation Infection in Secondary Care Management of Pain Heart Failure Cardiac Dysrhythmias Epilepsy • • • • • • Rational Drug Choice Root Cause Analysis Ethics and Consent Palliative and End-of-Life Care Systemic Anticancer Therapy and Cytotoxics Prescribing at the Interface & Team Prescribing Prescribing in Pregnancy Prescribing in Breastfeeding Paediatric Prescribing Dementia Friendly Prescribing SCRIPT Content Module Element Overview Contains: Comment • • The learning objectives provide a quick reference to what is going to be covered, and in what order. Trainees may choose to focus on a subsection of the module or complete it and obtain a certificate. • Pre-test Module activities Post-test Certificate Module overview Learning objectives/ prerequisites Introduction 10 multiple choice questions This can provide a good gauge of baseline knowledge. Only a mark (no feedback) is given. The same test is repeated as a ‘posttest’ at the end of the Module. Variety of activities The activities are varied but may include: • Case Vignettes • MCQ questions • Video scenarios • SimScript Interactive Case 10 multiple choice questions This is the same test as the ‘pre-test’, but there is some immediate feedback given on the answers. The answers on both tests are compared. If you have completed the entire Module and passed the post-test (≥50%), you are able to print off a certificate stating you have achieved the learning objectives for that Module. http://kss.safeprescriber.org/ SimScript • • Practical exercise activity Virtual Inpatient Chart Foundation doctor must review the chart – – – • • • • • May contain errors on any item Have missing items Interactions between medications Make amendments to the chart Asked questions by virtual pharmacist and consultant Requires methodical checking by the foundation doctor At the end the foundation doctor will ask the consultant to verify the chart Feedback the end SimScript SimScript SimScript SimScript SimScript SimScript SimScript Certificate of completion West Midlands • • In the West Midlands, a total of 31 modules are mandated over the 2-year Foundation Programme; 16 modules of which are to be completed in Foundation year 1: – – – – – – – – • Adverse Drug Reactions Anticoagulation Dosing and Calculation Drug Allergy and Anaphylaxis Drug Interactions Fluids Medication Errors Prescription Documentation — — — — — — — — Prescribing in Renal Dysfunction Prescribing in Older Adults Pain Management Parenteral Poisons Prescribing in Infection Rational Drug Choice Taking Drug History Toxic Tablets A further 15 modules of the trainee’s choice are to be completed in the second year. SCRIPT implementation • Current Pilot of 2 sites: SASH and ESHT • Identify: – Suitable mandatory modules – Time to complete each module – Duplication with face-to-face training • Information gathering regarding training on different in-house training. • Completion of implementation within trusts by the end of June 2014. Future plans for SCRIPT • Linked to the HEKSS Foundation Doctors Prescribing Assessment. • Discussion to formulate further modules for SCRIPT, specifically for psychiatry and other areas if needed. • Linking trends in errors with SCRIPT. Katie Reygate [email protected] Pharmacy Education
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