Editor–Miller and colleagues highlight the useful interventions of pharmacists in prescribing on consultant-led ward rounds (Clin Med August 2011 pp 312–16). We have previously shown how giving feedback to junior doctors on consultant-led ward rounds can lead to a reduction in prescribing errors.1 However, a major problem with this approach is that the doctor who wrote the drug chart is often not present on the round, as patients are quickly moved from the on-call or acute medical team to another ward. We therefore extended our work to a one-year study in which the pharmacist gave feedback to foundation year (FY) 1 doctors responsible for moderate or severe prescribing errors irrespective of the ward they worked on. Drug charts and take home prescriptions were systematically reviewed on three medical and one surgical ward by a single designated ward pharmacist who conducted the study. Feedback was given by the pharmacist face-to-face whenever possible (58% or errors), by telephone (26%) or by email if the trainee was otherwise difficult to contact (16%). The feedback was supplemented by six formal teaching sessions in which the prescribing errors were discussed in anonymised fashion.
In total, 275 errors were recorded by 25 FY1 doctors. The two most common errors were due to incorrect medication history itself, followed by wrong dose. There was a 62.8% reduction in total prescribing errors over the course of the year from 86 in the first eight weeks to 32 in the final eight weeks. Severe errors reduced by 92.3% from 13 in the first eight weeks to one in the final eight weeks. A questionnaire evaluation of the FY1 doctors' perceptions of the study revealed an overall feeling that providing feedback in this way was useful and effective. Six FY1s revealed that they had never received prescribing feedback from a senior member of their medical team. An important goal of ward pharmacists should be to educate. Receiving feedback on performance is the most powerful way to learn.2 Our study shows that pharmacists giving feedback to trainees on prescribing errors is feasible and effective even though they may not be working on the ward in which the errors were detected.
Footnotes
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- © 2011 Royal College of Physicians
Including pharmacists on consultant-led ward rounds
We thank Quantrill and Webbe for their response, and agree completely both that an important role of pharmacists is to educate, and that better systems are needed for providing feedback to prescribers about any errors made. We believe that feedback is complementary to pharmacist attendance on consultant ward rounds, and that both approaches are required. Pharmacists attending ward rounds are likely to be more aware of patients' current priority medical problems, and are able to discuss drug therapy with senior members of the medical team, resulting in the higher intervention rate demonstrated in our paper. Separately, better feedback on prescribing errors, particularly to junior doctors, is also needed, to facilitate learning. Several studies have shown that junior doctors get little or no feedback on their prescribing errors at present. We recently completed some exploratory work with junior doctors and pharmacists to explore these issues, and found a key barrier to be pharmacists unable to ascertain the identity of the prescriber. We are therefore considering piloting the use of name stamps, and are designing a controlled study to explore the impact of providing feedback to our junior doctors. We would encourage Quantrill and Webbe to publish their findings in more detail so that others can build on them further.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
