Safe Prescribing in Older Adults and Preparedness for Prescribing in Newly Qualified Doctors and Medical Students in Ireland.
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Prescribing errors are common in the hospital setting, and pose a significant risk to patient safety. Older adults are at risk of prescribing errors in view of their multi-morbidity and complex medication regimes. The majority of prescribing errors are preventable. Prescriber knowledge and skills are a key contributing factor to prescribing error prevalence. Prescriber education initiatives should be focused on recently qualified graduates and medical students, considering that they are responsible for the majority of prescribing in the clinical setting and in addition, the majority of prescribing errors.
The aims of this study were to identify prescribing error prevalence in the Irish hospital setting, and investigate how prepared newly qualified Irish trained doctors and medical students feel for prescribing in clinical practice. In order to identify the prevalence of prescribing errors in older adults, a study of 106 medication charts of patients aged 65 years and above acutely admitted to an 850 bedded hospital was carried out. A total of 504 prescribing errors were identified in the 1938 medication orders reviewed, with a prescribing error rate of 26.6% per 100 medication orders. This is significantly higher than the reported error rate in similar studies. This may be a result of the complex patient cohort in the study (mean age 77.58 95% CI 76.09-79.08; mean Charlson Comorbidity Index score 5.824, 95% CI 5.392-6.256; mean number of medications prescribed per patient was 18.46 (95% CI 16.58-20.33), and highlights that the older patient population are at high risk of prescribing errors in the acute hospital setting in Ireland.
Regarding causative factors for prescribing errors, preparedness for prescribing among newly qualified doctors and medical students was investigated. The first study aimed to investigate if newly qualified Irish trained doctors were prepared for prescribing through a national online survey. The response rate was 20.4% (n=140/686). Only 36% of newly qualified doctors agreed that their medical education had prepared them for prescribing in clinical practice. Confidence in the 4 skills of drug dose calculation and preparing and administering medications was low, as was the reported confidence in prescribing high risk medications such as opiate analgesics and sedation.
In order to investigate the preparedness of medical students, an online survey was distributed to final year medical students at the Royal College of Surgeons in Ireland (RCSI). The response rate was 38.3% (n=112/292). Only 20% of final year medical students agreed that their medical education had prepared them for prescribing 3 months before graduating as doctors. The majority of respondents (87%) reported that the amount of teaching in prescribing was too little, and that they were stressed (69%) about prescribing medications as an intern.
The final research aim was to facilitate the introduction of the Prescribing Safety Assessment (PSA) into RCSI for penultimate year medical students. The overall pass rate was low, with only 41% (n=39/95) of the students who participated in the assessment achieving the pass rate.
The role of individual factors in prescribing error rates is significant, and should be a key target for education initiatives. Educational opportunities for prescribers at both undergraduate and postgraduate level to improve preparedness should be adapted to ensure that newly qualified graduates are both prepared and competent to prescribe in clinical practice.