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St George's University Hospitals NHS Foundation Trust

Complementing theoretical learning with hands-on experience

People in a computer lab

Typically, at induction in their first year, foundation practitioners will be given theoretical training on prescribing. This will be supplemented throughout the year with some additional specialist prescribing teaching. Much of this uses paper drug charts, which are now somewhat outdated and no longer relevant for most of London, presenting a bit of a challenge. Although the theory of prescribing can still be taught and understood, the practical application with electronic prescribing systems can be largely missing.

For many junior doctors, their first experience of electronic prescribing and medicines administration (ePMA) systems is in a real-life ward environment. As such, the theme of many prescribing error reports and concerns voiced by junior doctors can involve both misunderstanding of theory of prescribing in addition to not knowing how to correctly use the ePMA system to prescribe. To remedy this, the team at St George’s decided that the best approach would be to combine theoretical teaching with practical use of ePMA, transforming the delivery to improve the experience for junior doctors and also to better cement learning.

The team started by asking for feedback on the top five problems pharmacists see with clinical prescribing in the system. As Catrin Page, clinical pharmacologist and acute medicine SpR tells us, “We knew where we thought the problems were, but wanted to get the views of junior doctors who were already working at the Trust – if this could help inform how we deliver training to the new cohort of F1s, we knew people would be keen to help out.”

The key areas were identified through feedback as well as prescription error reporting trends (through DATIX). These were then incorporated into the practical element of the teaching:

  • Prescribing oral anti-coagulants and following associated referral processes (e.g. DOACS warfarin)
  • Prescribing parenteral anticoagulants such as subcutaneous dalteparin and heparin infusions
  • Prescribing routine insulin and variable/fixed rate insulin
  • Prescribing antibiotics based on creatinine clearance

Catherine Chandler, specialist ePMA pharmacist, was instrumental in designing the structure of the teaching sessions to meet the needs of the junior doctors at induction. The teaching was split into three core areas:

  • Clinical theory understanding and problem solving
  • Translating theory into an electronic prescription
  • Safety netting

As well as the practical training, a series of support resources were made available for delegates to support them with the correct prescribing and local policies/procedures.

As Catherine says, “This was a significant investment in terms of time and resource to ensure clinical input and make the training scenarios as effective as possible. We really wanted realism but also for people to feel they had the necessary resources to make the correct prescribing decisions in the simulated environment.”

The new training approach was a great success – the team received positive feedback from delegates, which really made the investment worthwhile. Across 2019 and 2020, two hours of practical ePMA and theory training were delivered, with an increase to five hours in 2021. In addition to the standard training, there was also one further hour of specialised diabetes training using ePMA and the team hopes to be able to deliver more specialised training in this way in future.

Delegates were asked to score their own confidence levels both pre- and post-training in theoretical prescribing and ePMA prescribing ability. The response level was 78% and in 100% of cases, the Trust saw an increase in both theoretical and ePMA prescribing confidence levels.

Feedback indicated that delegates found the practical guided examples extremely helpful and having hands-on access to the ePMA system with real-life examples – and taught by a pharmacist – made all the difference.

St Georges NHS Trust callouts

Confidence in prescribing theory graph

Both Catherine and Catrin are really positive about the training delivery and have worked hard to understand what went well and document anything they’d do differently next time, given the opportunity. They hope their experience will inspire others to transform the way they deliver training, considering both the theoretical and practical elements as equally important.

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Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.