Safe Prescribing - Information for Foundation Doctors

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2018 BNF Familiarisation Answers.pdf526.28 KB
2018 BNF Familiarisation Questions.pdf515.51 KB
2018 Trust Prescribing Assessment Plans.pdf406.99 KB
Remediation letter for failed PSA.pdf55.29 KB

Introduction

Prescribing is one of the most common medical interventions with 500, 000 prescriptions being prescribed in UK hospitals every day, many of which are by foundation year 1 doctors. However it is widely recognised that prescribing errors are commonly made, particularly by new medical graduates. The incidence of this is reported in the EQUIP study which found that of 50,016 orders written by this group of trainees, there was an error rate of 8.4%, with 5.25% being classed as serious and 1.89% as potentially lethal.

The 2008 Health and Social Care Act includes the regulation that in order to protect patients against the risks associated with the unsafe use and management of medicines, there should be appropriate arrangements for each of the processes involved. In order to meet the regulations, it is necessary for NHS Trusts to be able to demonstrate that employees have the appropriate skills and competencies, including being able to prescribe safely and effectively.

Supporting Foundation Doctors Develop Their Prescribing Skills 

STFS trainees will be supported to develop their prescribing within foundation year in a variety of ways including: 

  • Prescribing assessment
  • SCRIPT
  • Local prescribing training
  • BNF Application

Foundation Doctors Prescribing Assessment (DPA)

The Foundation Doctors Prescribing Assessment was designed with 2 purposes:

  1. To ensure that newly employed foundation doctors are competent to prescribe safely using local drug charts / systems and local guidelines / resources
  2. To identify any additional training and support required to enhance prescribing skills.

Doctors are required to undertake the assessment in those trusts that participate, even if they have passed the Prescribing Safety Assessment. This is because the local Doctors Prescribing Assessment (DPA) tests a trainee’s ability to practically prescribe using local resources such as charts and guidelines, under time pressured conditions (similar to the ward) but in a safe environment – as no patients are involved. The assessment is marked and trainees are given feedback. Trainees can be given “serious errors” mark if they prescribe a medicines in a way that would lead to a Datix/ incident report in practice. In these cases further education may be mandated or further support. The assessment is intended to be supportive, as outlined in the comments from past trainees:

“very useful - highlighted key gaps in knowledge, drug chart is very different to one trained with.”

“useful to practice using the drug charts under pressurised conditions. Less time allowance may have made it more like on the wards-helpful thank you.”

“really useful to do this assessment - good to practice and see what we are likely to need to be prescribing regularly and what we need to go away and revise.”

“really useful to have this assessment to practice prescribing as drug chart very different to what I have been used to in medical school”

The assessment it 1 hour and 15 minutes long, and contains 5 scenarios. Please note the use of phones within the assessment is permitted to allow you to access the BNF and a calculator. Trainees are expected to come to the assessment with a fully charged phone and with the BNF app fully downloaded.

Details regarding the practical written assessment for incoming F1’s can be found in the 2018 Trust Prescribing Assessment Plans (available to download from the right-hand side of this page). This document outlines each trusts plan for training and assessing incoming F1s.

If you were granted additional time for examinations at university due to having additional educational needs, please contact the trust lead. Contact details are on the 2018 Trust Prescribing Assessment Plans.

Trainees can be involved in reviewing the assessment by attending the Prescribing Assessment Group - if you are interested please contact your local trust prescribing lead.  New attached document

SCRIPT

SCRIPT is an innovative e-Learning programme that provides trainees with a series of modules to explore prescribing and therapeutics. SCRIPT is an easily accessible web based programme comprising of over 40 modules, divided into 7 units covering competencies defined by the GMC and those required within the Foundation curriculum. The modules contain interactive videos, graphics and exercises. Each module is expected to take 30-90 minutes to complete.

Each foundation doctor is expected to complete 6 modules a year. You can access the South Thames Foundation School clone of SCRIPT here: https://kss3.safeprescriber.org/login

SCRIPT Mandated Modules

The SCRIPT eLearning is fully integrated in the STFS programme.   In both F1 and F2, you are required to complete a minimum of 6 mandatory modules per year. Each trust mandate modules for trainees to undertake based on the areas of high risk and incidents often raised. Please refer to local medical education centre for further details complete modules gradually over the year.

Medical education departments will monitor whether SCRIPT modules are being completed and that you are not completing modules in a hurry prior to review meetings.

SCRIPT module pre/post-test score

The pre/post-test is intended to help you determine your baseline knowledge on the module subject, and be a measure of knowledge acquisition.  It also adds an element of interactivity. The questions have not been reviewed by an examination board.  

Within the STFS SCRIPT site the post-test pass mark has been set at 70%. If a trainee fails to achieve 70% they will need to repeat the module. At the home screen the module will have a triangle with an examination mark symbol, if you click on this; it will allow you to retake the module.

More information can be found in the National Foundation SCRIPT guide found on the SCRIPT website: https://www.safeprescriber.org/wp-content/uploads/2017/08/script-guide-foundation.pdf

Local prescribing training

In addition to SCRIPT trusts may offer prescribing training as part of the teaching schedule. These sessions will be tailored to the training requirements of the trust and will include local policies and guidelines that must be followed.

BNF Application

All trainees undertaking the prescribing assessment are required to have access to the BNF application.

For trainees who have never used an BNF app or are unfamiliar with the BNF website the prescribing assessment group have created BNF Familiarisation Questions (available to download from the right-hand side of this page) for trainees to work through at their own pace, the answers are provided in the document BNF Familiarisation Question Answers 

Contact us

For further information on the Prescribing assessment and other safe prescribing initiatives, contact Katie Reygate STFS Prescribing Lead via email Katie.reygate@hee.nhs.uk

The Prescribing Safety Assessment

From 2016 all Foundation Doctors are required to successfully pass the Prescribing Safety Assessment (PSA) by the end of their first year of training. Trainees who successfully completed it at medical school will not be required to repeat it (unless it was passed more than 2 years before the start of foundation training).

Trainees who have passed the PSA will still be required to undertake the Foundation Doctors Prescribing Assessment on induction, as this tests the application of prescribing using local drug charts and prescribing systems.

Information on the PSA in foundation can be found on the UKFPO website.