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Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice.

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Τίτλος: Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice.
Συγγραφείς: Green W; University of Leicester School of Business, University of Leicester, Leicester, UK., Shahzad MW; University of Leicester School of Business, University of Leicester, Leicester, UK., Wood S; University of Leicester School of Business, University of Leicester, Leicester, UK., Martinez Martinez M; Leicester General Hospital, University Hospitals of Leicester (UHL) NHS Trust, Leicester, UK., Baines A; Pilgrim Hospital Boston, United Lincolnshire Hospitals (ULH) NHS Trust, Boston, Lincolnshire, UK., Navid A; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK., Jay R; School of Medicine, University of Nottingham, Nottingham, UK., Whysall Z; Department of Human Resource Management, Nottingham Business School, Nottingham Trent University, Nottingham, UK., Sandars J; Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK., Patel R; School of Medicine, University of Nottingham, Nottingham, UK.
Πηγή: British journal of clinical pharmacology [Br J Clin Pharmacol] 2020 Nov; Vol. 86 (11), pp. 2234-2246. Date of Electronic Publication: 2020 May 18.
Τύπος έκδοσης: Journal Article; Research Support, Non-U.S. Gov't
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 7503323 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2125 (Electronic) Linking ISSN: 03065251 NLM ISO Abbreviation: Br J Clin Pharmacol Subsets: MEDLINE
Imprint Name(s): Publication: Oxford : Wiley-Blackwell
Original Publication: London, Macmillan Journals Ltd.
Ιατρικοί όροι (MeSH): Medical Staff, Hospital* , Physicians*, Drug Prescriptions ; England ; Feedback ; Humans ; Practice Patterns, Physicians' ; Prospective Studies
Περίληψη: Aims: This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations.
Methods: Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness.
Results: There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention.
Conclusion: Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.
(© 2020 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
References: BMJ. 2016 May 03;353:i2139. (PMID: 27143499)
Pediatrics. 1987 May;79(5):718-22. (PMID: 3575028)
Acad Med. 1999 Oct;74(10 Suppl):S93-5. (PMID: 10536605)
BMC Med. 2004 Aug 18;2:29. (PMID: 15317650)
Res Social Adm Pharm. 2019 May;15(5):546-557. (PMID: 30041915)
Med Teach. 2005 Jan;27(1):10-28. (PMID: 16147767)
Neurorehabil Neural Repair. 2013 May;27(4):316-24. (PMID: 23270921)
JAMA. 1990 May 2;263(17):2329-34. (PMID: 2325234)
BMC Med Educ. 2011 Dec 06;11:101. (PMID: 22141427)
BMJ Qual Saf. 2013 Feb;22(2):97-102. (PMID: 23112288)
BMJ. 1999 May 8;318(7193):1267-9. (PMID: 10231262)
Qual Saf Health Care. 2008 Oct;17(5):360-3. (PMID: 18842975)
J Surg Educ. 2017 Jul - Aug;74(4):612-620. (PMID: 28041770)
Ann Emerg Med. 2012 May;59(5):369-73. (PMID: 22226174)
Teach Learn Med. 2002 Fall;14(4):223-8. (PMID: 12395483)
BMJ Qual Saf. 2014 Jan;23(1):17-25. (PMID: 23922405)
Acad Med. 2015 Nov;90(11):1471-86. (PMID: 26375267)
Clin Teach. 2015 Jun;12(3):187-92. (PMID: 26009954)
Surgery. 2018 Apr;163(4):921-926. (PMID: 29289390)
East Mediterr Health J. 2011 Feb;17(2):156-9. (PMID: 21735951)
Qual Saf Health Care. 2010 Aug;19 Suppl 2:i34-43. (PMID: 20693215)
Arch Intern Med. 1997 Jul 28;157(14):1569-76. (PMID: 9236558)
Eur J Hosp Pharm. 2016 Sep;23(5):294-301. (PMID: 31156868)
Qual Health Care. 2000 Dec;9(4):232-7. (PMID: 11101708)
PLoS Med. 2012 Jan;9(1):e1001164. (PMID: 22303286)
N Engl J Med. 2013 Oct 10;369(15):1434-42. (PMID: 24106936)
Adv Simul (Lond). 2016 May 17;1:13. (PMID: 29449982)
BMJ Qual Saf. 2017 Mar;26(3):240-247. (PMID: 27044881)
Med Educ. 2020 Jan;54(1):33-39. (PMID: 31475387)
Qual Saf Health Care. 2006 Dec;15(6):433-6. (PMID: 17142594)
Lancet. 2012 Apr 7;379(9823):1310-9. (PMID: 22357106)
JAMA. 1997 Jan 22-29;277(4):312-7. (PMID: 9002494)
Br J Clin Pharmacol. 2020 Nov;86(11):2234-2246. (PMID: 32343422)
Brain Inj. 2006 Sep;20(10):1061-8. (PMID: 17060139)
J Surg Educ. 2015 Jul-Aug;72(4):697-703. (PMID: 25703737)
BMJ. 2017 Oct 9;359:j4328. (PMID: 28993308)
Br J Clin Pharmacol. 2019 Oct;85(10):2405-2413. (PMID: 31313340)
Qual Saf Health Care. 2004 Jun;13(3):165-6. (PMID: 15175481)
Qual Health Care. 2000 Sep;9(3):159-65. (PMID: 10980076)
Am J Surg. 2004 Mar;187(3):427-32. (PMID: 15006577)
JAMA Netw Open. 2018 Nov 2;1(7):e184852. (PMID: 30646392)
Br J Clin Pharmacol. 2009 Jun;67(6):662-70. (PMID: 19594535)
Br J Surg. 2013 Oct;100(11):1448-53. (PMID: 24037563)
Stud Health Technol Inform. 2010;153:23-46. (PMID: 20543237)
Can J Surg. 2005 Jun;48(3):195-200. (PMID: 16013622)
Adv Health Sci Educ Theory Pract. 2012 Mar;17(1):15-26. (PMID: 21468778)
BMJ Qual Saf. 2018 Aug;27(8):655-663. (PMID: 29317463)
Acad Emerg Med. 2008 Nov;15(11):988-94. (PMID: 18778378)
BMJ Open. 2013 Aug 30;3(8):e003291. (PMID: 23996821)
BMJ Qual Saf. 2013 Mar;22(3):256-62. (PMID: 23038410)
Br J Clin Pharmacol. 2013 Feb;75(2):359-72. (PMID: 22831632)
Percept Mot Skills. 1993 Dec;77(3 Pt 1):907-13. (PMID: 8284175)
Grant Information: Funding for Study 2 and 3 Academic Health Science Network; LEI0085 Health Education England; R.P.'s academic clinical lecturership National Institute for Health Research; Unrestricted Medical Education Grant (Study 1) Pfizer UK
Contributed Indexing: Keywords: avoidable harm; deliberate practice; foundation training; junior doctors; patient safety; prescribing; video-enhanced feedback
Entry Date(s): Date Created: 20200429 Date Completed: 20210728 Latest Revision: 20210728
Update Code: 20260130
PubMed Central ID: PMC7576627
DOI: 10.1111/bcp.14325
PMID: 32343422
Βάση Δεδομένων: MEDLINE
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  Data: Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice.
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  Data: <searchLink fieldCode="AU" term="%22Green+W%22">Green W</searchLink>; University of Leicester School of Business, University of Leicester, Leicester, UK.<br /><searchLink fieldCode="AU" term="%22Shahzad+MW%22">Shahzad MW</searchLink>; University of Leicester School of Business, University of Leicester, Leicester, UK.<br /><searchLink fieldCode="AU" term="%22Wood+S%22">Wood S</searchLink>; University of Leicester School of Business, University of Leicester, Leicester, UK.<br /><searchLink fieldCode="AU" term="%22Martinez+Martinez+M%22">Martinez Martinez M</searchLink>; Leicester General Hospital, University Hospitals of Leicester (UHL) NHS Trust, Leicester, UK.<br /><searchLink fieldCode="AU" term="%22Baines+A%22">Baines A</searchLink>; Pilgrim Hospital Boston, United Lincolnshire Hospitals (ULH) NHS Trust, Boston, Lincolnshire, UK.<br /><searchLink fieldCode="AU" term="%22Navid+A%22">Navid A</searchLink>; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.<br /><searchLink fieldCode="AU" term="%22Jay+R%22">Jay R</searchLink>; School of Medicine, University of Nottingham, Nottingham, UK.<br /><searchLink fieldCode="AU" term="%22Whysall+Z%22">Whysall Z</searchLink>; Department of Human Resource Management, Nottingham Business School, Nottingham Trent University, Nottingham, UK.<br /><searchLink fieldCode="AU" term="%22Sandars+J%22">Sandars J</searchLink>; Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK.<br /><searchLink fieldCode="AU" term="%22Patel+R%22">Patel R</searchLink>; School of Medicine, University of Nottingham, Nottingham, UK.
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  Data: Aims: This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations.<br />Methods: Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness.<br />Results: There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention.<br />Conclusion: Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.<br /> (© 2020 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
– Name: Ref
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  Data: BMJ. 2016 May 03;353:i2139. (PMID: <searchLink fieldCode="PM" term="%2227143499%22">27143499)</searchLink><br />Pediatrics. 1987 May;79(5):718-22. (PMID: <searchLink fieldCode="PM" term="%223575028%22">3575028)</searchLink><br />Acad Med. 1999 Oct;74(10 Suppl):S93-5. (PMID: <searchLink fieldCode="PM" term="%2210536605%22">10536605)</searchLink><br />BMC Med. 2004 Aug 18;2:29. (PMID: <searchLink fieldCode="PM" term="%2215317650%22">15317650)</searchLink><br />Res Social Adm Pharm. 2019 May;15(5):546-557. (PMID: <searchLink fieldCode="PM" term="%2230041915%22">30041915)</searchLink><br />Med Teach. 2005 Jan;27(1):10-28. (PMID: <searchLink fieldCode="PM" term="%2216147767%22">16147767)</searchLink><br />Neurorehabil Neural Repair. 2013 May;27(4):316-24. (PMID: <searchLink fieldCode="PM" term="%2223270921%22">23270921)</searchLink><br />JAMA. 1990 May 2;263(17):2329-34. (PMID: <searchLink fieldCode="PM" term="%222325234%22">2325234)</searchLink><br />BMC Med Educ. 2011 Dec 06;11:101. (PMID: <searchLink fieldCode="PM" term="%2222141427%22">22141427)</searchLink><br />BMJ Qual Saf. 2013 Feb;22(2):97-102. (PMID: <searchLink fieldCode="PM" term="%2223112288%22">23112288)</searchLink><br />BMJ. 1999 May 8;318(7193):1267-9. (PMID: <searchLink fieldCode="PM" term="%2210231262%22">10231262)</searchLink><br />Qual Saf Health Care. 2008 Oct;17(5):360-3. (PMID: <searchLink fieldCode="PM" term="%2218842975%22">18842975)</searchLink><br />J Surg Educ. 2017 Jul - Aug;74(4):612-620. (PMID: <searchLink fieldCode="PM" term="%2228041770%22">28041770)</searchLink><br />Ann Emerg Med. 2012 May;59(5):369-73. (PMID: <searchLink fieldCode="PM" term="%2222226174%22">22226174)</searchLink><br />Teach Learn Med. 2002 Fall;14(4):223-8. (PMID: <searchLink fieldCode="PM" term="%2212395483%22">12395483)</searchLink><br />BMJ Qual Saf. 2014 Jan;23(1):17-25. (PMID: <searchLink fieldCode="PM" term="%2223922405%22">23922405)</searchLink><br />Acad Med. 2015 Nov;90(11):1471-86. (PMID: <searchLink fieldCode="PM" term="%2226375267%22">26375267)</searchLink><br />Clin Teach. 2015 Jun;12(3):187-92. (PMID: <searchLink fieldCode="PM" term="%2226009954%22">26009954)</searchLink><br />Surgery. 2018 Apr;163(4):921-926. (PMID: <searchLink fieldCode="PM" term="%2229289390%22">29289390)</searchLink><br />East Mediterr Health J. 2011 Feb;17(2):156-9. (PMID: <searchLink fieldCode="PM" term="%2221735951%22">21735951)</searchLink><br />Qual Saf Health Care. 2010 Aug;19 Suppl 2:i34-43. (PMID: <searchLink fieldCode="PM" term="%2220693215%22">20693215)</searchLink><br />Arch Intern Med. 1997 Jul 28;157(14):1569-76. (PMID: <searchLink fieldCode="PM" term="%229236558%22">9236558)</searchLink><br />Eur J Hosp Pharm. 2016 Sep;23(5):294-301. (PMID: <searchLink fieldCode="PM" term="%2231156868%22">31156868)</searchLink><br />Qual Health Care. 2000 Dec;9(4):232-7. (PMID: <searchLink fieldCode="PM" term="%2211101708%22">11101708)</searchLink><br />PLoS Med. 2012 Jan;9(1):e1001164. (PMID: <searchLink fieldCode="PM" term="%2222303286%22">22303286)</searchLink><br />N Engl J Med. 2013 Oct 10;369(15):1434-42. (PMID: <searchLink fieldCode="PM" term="%2224106936%22">24106936)</searchLink><br />Adv Simul (Lond). 2016 May 17;1:13. (PMID: <searchLink fieldCode="PM" term="%2229449982%22">29449982)</searchLink><br />BMJ Qual Saf. 2017 Mar;26(3):240-247. (PMID: <searchLink fieldCode="PM" term="%2227044881%22">27044881)</searchLink><br />Med Educ. 2020 Jan;54(1):33-39. (PMID: <searchLink fieldCode="PM" term="%2231475387%22">31475387)</searchLink><br />Qual Saf Health Care. 2006 Dec;15(6):433-6. (PMID: <searchLink fieldCode="PM" term="%2217142594%22">17142594)</searchLink><br />Lancet. 2012 Apr 7;379(9823):1310-9. (PMID: <searchLink fieldCode="PM" term="%2222357106%22">22357106)</searchLink><br />JAMA. 1997 Jan 22-29;277(4):312-7. (PMID: <searchLink fieldCode="PM" term="%229002494%22">9002494)</searchLink><br />Br J Clin Pharmacol. 2020 Nov;86(11):2234-2246. (PMID: <searchLink fieldCode="PM" term="%2232343422%22">32343422)</searchLink><br />Brain Inj. 2006 Sep;20(10):1061-8. (PMID: <searchLink fieldCode="PM" term="%2217060139%22">17060139)</searchLink><br />J Surg Educ. 2015 Jul-Aug;72(4):697-703. (PMID: <searchLink fieldCode="PM" term="%2225703737%22">25703737)</searchLink><br />BMJ. 2017 Oct 9;359:j4328. (PMID: <searchLink fieldCode="PM" term="%2228993308%22">28993308)</searchLink><br />Br J Clin Pharmacol. 2019 Oct;85(10):2405-2413. (PMID: <searchLink fieldCode="PM" term="%2231313340%22">31313340)</searchLink><br />Qual Saf Health Care. 2004 Jun;13(3):165-6. (PMID: <searchLink fieldCode="PM" term="%2215175481%22">15175481)</searchLink><br />Qual Health Care. 2000 Sep;9(3):159-65. (PMID: <searchLink fieldCode="PM" term="%2210980076%22">10980076)</searchLink><br />Am J Surg. 2004 Mar;187(3):427-32. (PMID: <searchLink fieldCode="PM" term="%2215006577%22">15006577)</searchLink><br />JAMA Netw Open. 2018 Nov 2;1(7):e184852. (PMID: <searchLink fieldCode="PM" term="%2230646392%22">30646392)</searchLink><br />Br J Clin Pharmacol. 2009 Jun;67(6):662-70. (PMID: <searchLink fieldCode="PM" term="%2219594535%22">19594535)</searchLink><br />Br J Surg. 2013 Oct;100(11):1448-53. (PMID: <searchLink fieldCode="PM" term="%2224037563%22">24037563)</searchLink><br />Stud Health Technol Inform. 2010;153:23-46. (PMID: <searchLink fieldCode="PM" term="%2220543237%22">20543237)</searchLink><br />Can J Surg. 2005 Jun;48(3):195-200. (PMID: <searchLink fieldCode="PM" term="%2216013622%22">16013622)</searchLink><br />Adv Health Sci Educ Theory Pract. 2012 Mar;17(1):15-26. (PMID: <searchLink fieldCode="PM" term="%2221468778%22">21468778)</searchLink><br />BMJ Qual Saf. 2018 Aug;27(8):655-663. (PMID: <searchLink fieldCode="PM" term="%2229317463%22">29317463)</searchLink><br />Acad Emerg Med. 2008 Nov;15(11):988-94. (PMID: <searchLink fieldCode="PM" term="%2218778378%22">18778378)</searchLink><br />BMJ Open. 2013 Aug 30;3(8):e003291. (PMID: <searchLink fieldCode="PM" term="%2223996821%22">23996821)</searchLink><br />BMJ Qual Saf. 2013 Mar;22(3):256-62. (PMID: <searchLink fieldCode="PM" term="%2223038410%22">23038410)</searchLink><br />Br J Clin Pharmacol. 2013 Feb;75(2):359-72. (PMID: <searchLink fieldCode="PM" term="%2222831632%22">22831632)</searchLink><br />Percept Mot Skills. 1993 Dec;77(3 Pt 1):907-13. (PMID: <searchLink fieldCode="PM" term="%228284175%22">8284175)</searchLink>
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  Data: Funding for Study 2 and 3 Academic Health Science Network; LEI0085 Health Education England; R.P.'s academic clinical lecturership National Institute for Health Research; Unrestricted Medical Education Grant (Study 1) Pfizer UK
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          Name:
            NameFull: Patel R
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 11
              Text: 2020 Nov
              Type: published
              Y: 2020
          Identifiers:
            – Type: issn-electronic
              Value: 1365-2125
          Numbering:
            – Type: volume
              Value: 86
            – Type: issue
              Value: 11
          Titles:
            – TitleFull: British journal of clinical pharmacology
              Type: main
ResultId 1