The effect of prescriber education on medication‐related patient harm in the hospital: a systematic review

Bos, Jacqueline M.; Bemt, Patricia M. L. A. van den; Smet, Peter A. G. M. De; Kramers, Cornelis

doi:10.1111/bcp.13200

Cited by 24 publications

(19 citation statements)

References 36 publications

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“…However, there are a number of studies that have used a multi-intervention study involving education alongside other interventions such as changes in protocols or feedback to trainees. On the whole, our reduction in error rate of 26% on all charts during the intervention is comparable to these multi-intervention studies [24]. Interestingly, the greatest error rate reduction was seen in the re-charts during the intervention, more than twice the reduction in error rate seen in primary charts, and above the reduction rate found in other studies.…”

Section: Discussionsupporting

confidence: 85%

The MOWER (middle of the week everyone gets a re-chart) pilot study: reducing in-hospital charting error with a multi-intervention

Floyd

Mårtensson

Bailey

et al. 2019

BMC Health Serv Res

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Background Medication charting errors occur often and can be harmful for patients. Interventions to improve charting errors have demonstrated some success particularly if the intervention uses multiple approaches including an education component. The aim of this pilot study was to determine whether a multi-faceted intervention, including education of junior doctors and weekday re-charting could reduce in-hospital charting error. Methods Medication charts ( n = 579) of all patients admitted to the medical ward of a medium sized regionally-based hospital in Australia over nine months (baseline and during intervention) were inspected for errors. The intervention ran for three months and involved implementation of a National Inpatient Medication Chart targeted error tool with eight targeted charting requirements which was used for visual reminders in the ward and training of junior doctors. In addition, mid-weekly re-charting (MOWER) was performed by a senior and junior doctor team. Results The mean number of charting requirement errors significantly reduced during the intervention by 26% from 4.6 ± 1.3 to 3.4 ± 1.7 per chart ( p < 0.001). Re-chart errors reduced on average by 50% (4.4 ± 1.4 to 2.2 ± 1.7 per chart, p < 0.001) and primary (initial) charts by 20% (4.6 ± 1.3 to 3.7 ± 1.5 per chart, p < 0.001) during the intervention. Failing to provide indication information for a drug, prescriber name, and failing to use generic rather than brand names were the categories with the most errors at baseline and also showed the largest error reductions during the intervention. Conclusions A multi-intervention including education of junior doctors, visual reminders and midweek re-charting are effective in reducing the rate of charting errors. We advise that a larger study is now conducted using the same multi-intervention strategy in different ward settings to evaluate feasibility and sustainability of this intervention. Electronic supplementary material The online version of this article (10.1186/s12913-019-4230-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 85%

The MOWER (middle of the week everyone gets a re-chart) pilot study: reducing in-hospital charting error with a multi-intervention

Floyd

Mårtensson

Bailey

et al. 2019

BMC Health Serv Res

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“…Educating prescribers is a measure that can be taken on top of other measures to improve guideline adherence. Educating prescribers is only effective if it is a part of a multifaceted intervention [ 35 ]. Novel of the P-REVIEW education program is the combination with a weekly visit by the hospital pharmacist, who audited and improved guideline adherence.…”

Section: Discussionmentioning

confidence: 99%

A multifaceted intervention to reduce guideline non-adherence among prescribing physicians in Dutch hospitals

Bos

Natsch

Bemt³

et al. 2017

Int J Clin Pharm

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Background Despite the potential of clinical practice guidelines to improve patient outcomes, adherence to guidelines by prescribers is inconsistent. Objective The aim of the study was to determine whether an approach of introducing an educational programme for prescribers in the hospital combined with audit and feedback by the hospital pharmacist reduces non-adherence of prescribing physicians to key pharmacotherapeutic guidelines. Setting This prospective intervention study with a before–after design evaluated patients at surgical, urological and orthopaedic wards. Method An educational program covering pain management, antithrombotics, fluid and electrolyte management, prescribing in case of renal insufficiency, application of radiographic contrast agents and surgical antibiotic prophylaxis was presented to prescribers on the participating wards. Hospital pharmacists performed medication safety consultations, combining medication review of patients who are at risk for drug related problems with visits to ward physicians. Main outcome measure The outcome measure was the proportion of the admissions of patients in which the physician did not adhere to one or more of the included guidelines. Difference was expressed in odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was performed. Results 1435 Admissions of 1378 patients during the usual care period and 1195 admissions of 1090 patients during the intervention period were included. Non-adherence was observed significantly less often during the intervention period [21.8% (193/886)] as compared to the usual care period [30.5% (332/1089)]. The adjusted OR was 0.61 (95% CI 0.49–0.76). Conclusion This study shows that education and support of the prescribing physician can reduce guideline non-adherence at surgical wards.

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“…More initiatives are taken worldwide to improve education on safe pharmacotherapy and to assess pharmacotherapy knowledge or skills [26]. For example, recently, there was a report about a nationwide initiative for an online prescribing Fig.…”

Section: Tests Completedmentioning

confidence: 99%

Towards a “prescribing license” for medical students: development and quality evaluation of an assessment for safe prescribing

Jansen

Keijsers

Kornelissen

et al. 2019

Eur J Clin Pharmacol

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Purpose This report describes the development and validation process of an assessment with national consensus in appropriate and safe pharmacotherapy. Methods A question-database on safe prescription based on literature of pharmacotherapy-related harm was developed by an expert group from Dutch medical faculties. Final-year medical students concluded a 2-year education program on appropriate and safe prescription by one of nine assessment variants of 40 multiple-choice questions each. An expert panel of professionals (n = 10) answered all database questions and rated questions on relevance. Questions were selected for revision based on lack of relevance or poor test and item characteristics. Results A total of 576 final-year medical students of the Radboud University was assessed. There was no significant difference in performance between students and content expert group (p = 0.7), probably due to learning behavior. Out of 165 questions, 59 were selected for revision. Conclusion Joint national effort from a team of experts in prescription and pharmacotherapy is an appropriate way to achieve a valid and reliable last-year student drug prescription assessment.

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The effect of prescriber education on medication‐related patient harm in the hospital: a systematic review

Cited by 24 publications

References 36 publications

The MOWER (middle of the week everyone gets a re-chart) pilot study: reducing in-hospital charting error with a multi-intervention

The MOWER (middle of the week everyone gets a re-chart) pilot study: reducing in-hospital charting error with a multi-intervention

A multifaceted intervention to reduce guideline non-adherence among prescribing physicians in Dutch hospitals

Towards a “prescribing license” for medical students: development and quality evaluation of an assessment for safe prescribing

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