From Safe to Safer Prescribing Dr Ajay Bedi Dean Director Northern Deanery Foundation School

NORTHERN DEANERY & PARTNER TRUSTS

NDFS - for entry August F1 posts-NESHA 39 F1 posts- NWSHA Total number “standard F1” academic / ? military

Session Aims Explain Background Outline Safer Prescribing Module Group Work

Reflections on a Process “Doctors Prescribing Rights Suspended” Northern Echo, Daily Mail, ITV Prescribing Assessment Skill Acquisition 100%!! IT’S A TEST!

NORTHERN DEANERY FOUNDATION SCHOOL F1 SAFE PRESCRIBING SKILLS ASSESSMENT PLEASE READ CAREFULLY BEFORE STARTING ASSESSMENT This assessment contains 8 questions addressing the learning outcomes of the safe prescribing module It is intended as a formative exercise to identify any additional training needs you may have in relation to these To demonstrate achievement of the learning outcomes you will need to achieve the pass mark for each question Should you not achieve this on this occasion you will be given further training targeted at the needs the assessment has identified and then given further opportunities to undertake the assessment until you are able to do so It is strongly recommended that you use the BNF during the assessment The use of calculators is permitted Blank prescription forms can be found as the appendices to this paper. Each one is labelled with the question number Your answers should be legible and prescription forms completed to the documentation standard of your Trust Please note that all patient details are fictitious and that you should assume that all the drugs prescribed are available in your hospital formulary Assessor use only

QUESTION 1 A frail 85-year-old gentleman is admitted from a nursing home with pyelonephritis. The letter from the nursing home states that his usual medication is: Aspirin 75mg each morning Digoxin mg each morning, Paracetamol 1g qds. He also requires IV cefuroxime 750mg tds for the pyelonephritis (to be given for 24hours and then reviewed). Write up a drug chart for this gentleman. He has no known allergies). Patient: Benjamin Witton Hospital No: Address: 1 Perth Road Yarm DOB: 9/4/22 Consultant: Dr A Baker Ward: 29

Reflections on a Process : Safe Prescribing Assessment Group 2007 Re-launch of Module Formative/Repeated Assessment/6 weekly cycle/£ Using BNF 2.Writing a Prescription 3.Calculate and transcribe Drug Dosage/Infusion Rates 4.Take, Interpret and Use a Drug and Allergy History 5.Recognise Limitations and how to access other resources

Reflections on a Process IT’S STILL A TEST!!

Reflections on a Process WORKING PARTY-2008 January/March/May Directors of Medical Education in Trusts Medical Directors Pharmacists Foundation Programme Tutors Trainees Patient community

Reflections on a Process Skill Set Day 1 Compendium of Prescribing Skills Minimum Standard Development Tool Integration in Ethos of FP

Minimum Standard Developmental Tool New F1s complete the tool during Shadowing (Trusts picking up any F1s who do not attend Shadowing ASAP into F1 year) The tool would be assessing the F1’s skill level, mapped against what is considered to be the minimum standard we would expect this level of doctor to possess on ‘day 1’ of F1 The content of the tool would be developed and drafted by the School’s Prescribing Working Group SAFE PRESCRIBING FRAMEWORK

The minimum standard tool reflects key prescribing skills in four domains: Transcribing Initiating new treatment (including calculations and infusions) Reviewing prescription Discharge. SAFE PRESCRIBING FRAMEWORK

Prescribing Discussion within the F1’s first meeting with their Educational Supervisor As soon as possible upon commencing in post, the F1 will meet with their Educational Supervisor. Part of this initial meeting should include a specific discussion about prescribing, looking at how the F1 performed in the Minimum Standard Development Tool and any outstanding competencies this tool has exposed within a supportive environment. As an outcome of this meeting, a developmental action plan is drawn up for the trainee then to complete to enable them to demonstrate all required competencies for prescribing. SAFE PRESCRIBING FRAMEWORK

Prescribing Training Package: Delivered at Trust-level The School’s Prescribing Framework will continue to include relevant training delivered within each Trust. SAFE PRESCRIBING FRAMEWORK

Demonstration that Prescribing Competencies have been met Following the action plan drawn up early-on in the F1 year with their Educational Supervisor, the trainee gathers evidence to demonstrate (over an appropriate time-period) that all required competencies related to prescribing have been met. Trainees should be encouraged to demonstrate competence via the workplace based assessment tools already in place within FP (e.g. DOPS) and progress regularly discussed within meetings with their Educational Supervisor SAFE PRESCRIBING FRAMEWORK

KEY PARTNERS The role of the Trust in delivering the process. The critical engagement role of the Educational Supervisor in developing with the F1 trainee an action plan against the outcomes from the minimum standard development tool. Trusts will of course, need to have a plan in place to manage trainees who do not demonstrate “the day one of F1” key skills. SAFE PRESCRIBING FRAMEWORK

University Challenge GMC Education Committee Study Undergraduate Curriculum Partnership SAFE PRESCRIBING FRAMEWORK

“I have learned throughout my life as a composer chiefly through my mistakes and pursuits of false assumptions, not by my exposure to founts of wisdom and knowledge” Igor Stravinsky