Prescribing and Therapeutics Dr L Varadhan C2017 Meeting – Doctor as Practitioner 1 st June 2016

Agenda Current teaching offered year-wise in hospitals What is expected at the end of academic years Broad overview of changes needed

Y3 – What is being done Introductory prescribing session – induction Y3 pharmacology sessions – Increased familiarity with drugs in relation to clinical scenarios Block-based teaching Wrap-up session – include 10 drugs Sign off – 18 classes of drugs Handbook changes

Y3 Handbook

MISTIME CategoriesExplanation Mode of actionBroadly what class IndicationsCommon clinical indications, drug of choice, contraindications Side-effectsCommon expected side effects; major adverse reactions Therapeutic evaluationIn context of the medical issue (stop/start/ withhold/ reduce/ continue), renal and hepatic function, planning for pregnancy, etc. InteractionsWith other used drugs, affect on metabolism MonitoringIf required; and how; for drug levels; for side effects EducationPatient information, timing, dietary changes, monitoring, alcohol

Y3 Handbook

Expectations - At end of Y3 Familiarity with common classes of drugs – basic pharmacology profile: name and class of drug, mechanism of action, indication and contraindications Taking a good and comprehensive drug history – Including alternative and OTC medications Approach a drug chart and able to identify the drugs, indications, side effects (MISTIME) Good familiarity with BNF

Y3 – What needs to be done Gap between Y2 and Y5 with respect to drugs and prescribing Pharmacology/therapeutics teaching to be spread across the year – CBL tutor training CBL – to include discussion on drugs Continued familiarity with drugs – all tutors Others – Classes of drugs aligned to BNF criteria – Consolidation prescribing session as part of Keele Spine – Antibiotic prescribing session SCRIPT access and PSA introduction

Y4 Y4 prescribing workshops Y4 pharmacology session – Reduce number of cases of therapeutic evaluation – Slide presentation to give more direction and structure Block-specific teaching – ID team: lecture at Keele Spine on TB and HIV drugs – O&G: Contraception Sign-offs on the log books

Y4 Handbook

Y4 handbook

Expectations at end of Y4 Familiarity with most of the drugs – Understand monitoring for effect and side-effect – Able to identify a wrongly written drug Understand interactions of drugs Therapeutic evaluation of a drug chart – Tailored to patient clinical condition

Y4- what needs to be done Y5 content to be started in Y4 CIL presentations to include drug lists – Tutor and student notes to include this Prescribing and therapeutics teaching should be embedded across the year – Block Leads and Firm tutors Introduction to SCRIPT access Limited SOP for Y4 prescribing in hospitals Introduction to PSA and Mock exam

Y5 Prescribing SOP – Hospital prescribing – ‘Purple pen’ prescribing – Student assistantship programme SCRIPT access and usage Assistantship – Constituting and administration of drugs

Y5 Session 1: Prescribing skills Session 2: Diabetes cases Session 3: Therapeutic evaluation Session 4: Delivered in GP Pharmacist and diabetes nurses involved

Y5 Induction day at RSUH/SaTH safe prescribing lecture GP away day – Day 1:Death certification & PSA exam – Day 2: IV fluid prescribing & prescribing – renal and gentamicin prescribing EOL prescribing – Delivered at hospice – Orientation to PRN/syringe driver prescribing of EOL meds

Y5 – Pharmacist teaching Session 1: Prescribing safety ( at beginning of the block) Session 2: (mid) – TTO and discharge letters Session 3: (mid) – Heparin/ warfarin and NOAC therapy

Expectations at Y5 completion Being a safe and effective prescriber Feeling confident to start prescribing as F1 Broad knowledge of various drugs, therapeutic issues, guidelines and evidence base – Assess risk vs benefit Pass the PSA exam/summative assessment

Y5 -What needs to be done SCRIPT – increase uptake – Changes to induction session – ?make mandatory PSA in January/February – Completion of teaching for GP and Hospital Block by then – Changes to the presentation materials – Renal prescribing, therapeutic evaluation, TTO Assistantship – Continued emphasis on drug review and prescribing – Few sessions with the pharmacist on ward round? Uniformity at SaTH and UHNM

General issues RIME model Cross delivery across various sites - hospitals/GPs Tutor awareness Signposting of pharmacology and therapeutics Y3 gap in pharmacology – Vertical integration in Y3 curriculum Y5 duration before PSA