New Study on How Junior Doctors Prescribe Will Investigate Impact of Clinical Decision Support Systems in Preventing Errors

Leicester, UK — (7 August 2013) —Wolters Kluwer Health, a leading global provider of information for healthcare professionals and students, announced today that its clinical decision support (CDS) system, UpToDate®, will serve as a key clinical resource in a new study, Prescribing Insight for the Future (ePIFFany), being conducted at the University Hospitals of Leicester NHS Trust.

Researchers at University Hospitals of Leicester NHS Trust and the University of Leicester received a grant from the East Midlands HIEC to develop an educational intervention for reducing prescribing errors among junior doctors. They will be evaluating the decisions made by junior doctors and exploring how these contribute to many of the clinical errors seen in the hospital setting. UpToDate has been the subject of over 30 global research studies, which confirm that evidence-based clinical information delivered in real time is associated with a reduction in clinical errors and improved patient outcomes, and has been shown to have a positive impact on the medical education of junior doctors. 

According to researchers from the Dr. Foster Unit at London’s Imperial College, there is extensive evidence of increased risk to patients as new doctors begin caring for patients on the first Wednesday in August when junior doctors arrive on the wards. Under the current system, people admitted to NHS hospitals as an emergency on what has come to be known as ‘Black Wednesday’ have, on average, a greater risk of avoidable harm than those admitted on the previous Wednesday. The General Medical Council commissioned a study looking more closely at prescribing behaviour among junior doctors across 19 hospitals in the UK and found that 8.9% of all prescriptions contained some form of avoidable error.

The aim of ePIFFany is to study the use of education in reducing clinical errors and to improve the knowledge, skills and prescribing performance of junior doctors in clinical practice. Researchers at the University of Leicester aim to improve the prescribing behaviour of junior doctors in the NHS, which will save lives as well as time and money. Junior doctors will undergo a 10-week teaching programme comprising face-to-face sessions and discussion around key topics involving prescribing in renal disease. The teaching is also supported by case-based learning opportunities using virtual patient scenarios to scaffold any knowledge gaps among the doctors.

UpToDate has donated individual subscriptions to provide knowledge and diagnostic clinical decision-making support in these simulations and educational interventions via the UpToDate Mobile app. Accessing UpToDate on a tablet or smartphone will provide junior doctors with 'just-in-time' knowledge and diagnostic clinical decision-making support when and where they need it. 

Dr. Rakesh Patel, NIHR Academic Clinical Lecturer in Medical Education/Honorary Specialist Registrar in Nephrology and Lead Investigator of the Prescribing Insight for the Future (ePIFFany) study said, “The aim of this study is to use a blend of technology-enhanced learning and face-to-face teaching to reduce clinical errors and improve the knowledge, skills and prescribing performance of junior doctors in the workplace. Alongside computer-based learning and simulation, we hope the use of evidence based clinical decision support technology, such as UpToDate, will provide junior doctors with 'just-in-time' knowledge for safe clinical diagnostic decision-making. This, in turn, should result in a reduction of prescribing errors and increased patient safety.”

The effectiveness of education will be measured by comparing error rates, error severity and medication error types on real patient prescription charts before and after implementation of the intervention. In the short term, the project will increase the knowledge and skills required by junior doctors for safe prescribing. The study hopes to demonstrate the benefit of educational tools and clinical decision support technology in helping reduce the rate, severity and type of medication prescribing errors. The aim of the intervention is to demonstrate an increase from baseline of the prescribing knowledge and general knowledge skills of junior doctors.

“The timely research project led by Dr. Patel will shed new light on how to improve the training of junior doctors while increasing patient safety especially during critical transitions like Black Wednesday,” said Denise Basow, MD, Vice President/General Manager and Editor-in-Chief, UpToDate at Wolters Kluwer Health, Clinical Solutions. “The thousands of clinical topics and actionable recommendations contained in UpToDate play a central role in equipping junior doctors with the competence and confidence they need to answer clinical questions at the point of care.”

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