Pharmacist-led feedback workshops increase appropriate prescribing of antimicrobials

Abstract

Objectives: To investigate whether and how structured feedback sessions can increase rates of appropriate antimicrobial prescribing by junior doctors.Methods: This was a mixed-methods study, with a conceptual orientation towards complexity and systems thinking. Fourteen junior doctors, in their first year of training, were randomized to intervention (feedback) and 21 to control (routine practice) groups in a single UK teaching hospital. Feedback on their antimicrobial prescribing was given, in writing and via group sessions. Pharmacists assessed the appropriateness of all new antimicrobial prescriptions 2 days per week for 6 months (46 days). The mean normalized prescribing rates of suboptimal to all prescribing were compared between groups using the t-test. Thematic analysis of qualitative interviews with 10 participants investigated whether and how the intervention had impact.Results: Data were collected on 204 prescriptions for 166 patients. For the intervention group, the mean normalized rate of suboptimal to all prescribing was 0.32+0.36; for the control group, it was 0.68+0.36. The normalized rates of suboptimal prescribing were significantly different between the groups (P ¼ 0.0005). The qualitative data showed that individuals' prescribing behaviour was influenced by a complex series of dynamic interactions between individual and social variables, such as interplay between personal knowledge and the expectations of others. Conclusions:The feedback intervention increased appropriate prescribing by acting as a positive stimulus within a complex network of behavioural influences. Prescribing behaviour is adaptive and can be positively influenced by structured feedback. Changing doctors' perceptions of acceptable, typical and best practice could reduce suboptimal antimicrobial prescribing.

Pharmacist‐led, video‐stimulated feedback to reduce prescribing errors in doctors‐in‐training: A mixed methods evaluation

“…Although usually attributed to an individual prescriber, it is increasingly clear that prescribing errors are typically multifactorial, involving multiple people working in a complex, interrelated and fast-moving healthcare systems. [6][7][8][9] This means that solutions that focus on a single cause, such as a knowledge deficit, are likely to lead to limited benefits. 7,10,11 The social elements of healthcare team working are increasingly recognised as important in relation to prescribing errors.…”

“…Importantly, they sit outside the medical hierarchy, and have been suggested as well placed to support and develop the prescribing practices of doctors-in-training (e.g. 9,15 ). Recent research from Australia highlighted significant potential for co-working between doctors-intraining and pharmacists to develop effective prescribing practices, for example through pharmacists developing roles in learning facilitation rather than error identification.…”

“…16 McLellan et al demonstrated that a structured feedback session for doctors-in-training facilitated by pharmacists based on real patient cases increased rates of appropriate antimicrobial prescribing. 9 Importantly, Noble et al 23 advocated greater emphasis on interprofessional collaboration for learning in everyday activities and interactions, rather than more traditional approaches to education which often occur beyond the everyday work setting. Therefore, we developed a model of pharmacist-led feedback for doctors-in-training that was embedded within their work environment and aligned to their everyday prescribing tasks.…”

Optimising feedback for early career professionals: a scoping review and new framework

“…the social world is a complex one and we would not therefore be able to explain how or why our intervention had an effect on the basis of numeric data alone …”

“…the social world is a complex one and we would not therefore be able to explain how or why our intervention had an effect on the basis of numeric data alone. 28 Finally, our search does not claim to be exhaustive and the feedback framework developed is just one interpretation, but we hope it can start an interesting and important conversation about workplace-based feedback for ECPs.…”