New Blog Post: using video feedback to reduce junior doctor’s prescribing errors

This week we talk to Karen Mattick (University of Exeter) and  Odran Farrell (Royal Devon & Exeter NHS Foundation Trust) about their project which uses video feedback to reduce junior doctor’s prescribing errors.
Karen Mattick, Professor of Medical Education, explains: “We were aware that prescribing errors are common and that junior doctors were an important target group for interventions, since they may make more mistakes than senior doctors and write the most prescriptions in hospital settings.  Recent research highlights an important role for pharmacists in supporting junior doctors to improve their prescribing capabilities.  We were also aware that performance feedback is likely to have significant educational impact.”
Odran Farrell, Clinical Pharmacist says: “We developed and implemented a simple prescribing feedback intervention as we kept hearing that junior doctors were getting very little in the way of feedback. There was a study carried out in a renal unit in Leicester, which was quite resource heavy. We liked the approach but were concerned about the resource implications – so we picked the option of filming, as video-based feedback is increasingly used in medical schools.  We devised a pharmacist-led feedback project for junior doctors, where we filmed them taking the drug histories of real patients and writing up their drug charts, with a Go Pro camera. A pharmacist then watched the footage and met with the junior doctor to review it together, discuss the good aspects of their practice and explore where there were areas to improve on.
At the same time, we collected data on the number of pharmacist interventions in the same ward areas and we discovered a reduction of about 40% in prescribing errors after the intervention, which is an amazing reduction given that it involves very little cost and time to implement. The only capital cost of the project was the Go Pro camera at £150-£250. The investment of pharmacist time was offset by the time saved downstream helping to correct errors, so it represents a net saving of time – not to mention the potential financial and human cost associated with each medication error.”
Karen continues: “Sixteen of twenty five (64%) junior doctors rotating through the surgical admissions unit of RD&E received feedback on their prescribing.  The 40% reduction in the mean number of pharmacist interventions (each equating to a prescribing error in some form) after implementation was impressive. Most prescribing errors would have had minimal risk of harm to patients but a small number of errors were more serious.  The feedback intervention was generally well received by junior doctors. On reviewing the video footage, participants and pharmacists noted the dynamic and distracting locations chosen by junior doctors to prescribe medicines and complete documentation: “Probably the thing I think I learnt the most was watching how many times I got interrupted whilst prescribing.  A drug chart is what 10 minutes I think I got interrupted 12 times during the process”. After the project, many junior doctors used office space instead of the busy ward to undertake this task.”
Odran concludes: “We concluded that everyone benefits from junior doctors receiving feedback on their prescribing practice – and that pharmacists are well placed to provide it.  The use of video-based reflection, for example in the environment in which prescriptions are written, has led to behaviour change.  Implementing this approach more widely would reduce prescription errors still further and improve support and development of junior doctors. Going forward we are looking at ways we can incorporate this into daily process.”
If you would like more information about this project please contact Karen Mattick  (k.l.mattick@exeter.ac.uk) or Odran Farrell (o.farrell@nhs.net).  Hazel Parker, Ali Hodgetts & Rob Bethune were also involved in the project.