Retrospective review of prescriptions issued by GPs in Training

Problem

The GMC PRACtICe study identified prescribing errors in general practice occurring at a rate of about one in every twenty prescriptions. GPs in training (GP AiTs) were specifically highlighted as a cohort of prescribers who may benefit from further help in order to reduce their prescribing errors. We report on the development of one educational intervention that has been developed as a result of findings from the PRACtICe study: a personalised review of prescriptions issued by GP AiTs.

Approach

Ten GP AiTs had one hundred sequential prescriptions retrospectively assessed by a specially trained pharmacist. Case law from the GMC PRACtICe study was employed to justify a decision regarding the suitability of a prescription with new case law being scrutinised by an expert panel. Details of all prescribing errors and suboptimal prescribing was relayed to each of the GP AiTs and their trainer in the form of a written report and a feedback interview. Quantitative data were pooled in order to ascertain the spread of prescribing errors and suboptimal prescribing for the whole cohort of ten GP AiTs. The GP AiT and their trainer were invited to attend an immediate and 3 month follow up interview. These interviews were transcribed verbatim and analysed for emergent themes.

Findings

Pooled data from the 10 GP AiTs suggested that prescribing errors occurred at a rate higher than that of the PRACtICe study (9%). There was a very high rate of ‘suboptimal prescribing’ (45%), which included aspects of poor practice such as providing incomplete information on a prescription. Preliminary qualitative analysis of the initial and follow-up interviews provided indication that the intervention had an impact on the prescribing practice of not only the GPAiT but also of their trainers. Both GP AiTs and trainers reported changes implemented such as writing clear instructions for dosage directions to make the prescription more accessible to patients and to remove ambiguity for the patient and practitioners involved in the dispensing process. Taking part in the study was reported to have raised the awareness of the GPAiTs to the availability of guidelines, especially in the area of antibiotic prescribing.

Consequences

The rate of prescribing errors among the ten GP AiTs was almost twice that reported in the PRACtICe study. Our study only involved a small number of GP AiTs, and so caution must be employed before extrapolating these findings to a larger population of GP AiTs. This initial pilot study would, however, be supportive of the view that GP AiTs may benefit from further help to improve prescribing practice. Qualitative data are supportive of the individualised feedback process providing a catalyst for change in practice of both the GP AiT and their trainer, with a resultant positive impact on patient safety.