Computer software helps new medical graduates prescribe safely

The SCRIPT (Standard Computerised Revalidation Instrument for Prescribing and Therapeutics) project has brought together a team of experts from Aston University (UK) and Birmingham and Warwick Medical Schools (UK) to create this innovative, e-learning toolkit.

Doctors who have recently graduated from medical school have to prescribe safely from day one on the wards. Their task is made harder by the many new drugs that have been introduced, as well as the rapid throughput of patients who are often sicker and older and who are more likely to suffer adverse drug reactions (drug side effects).

Sub-optimal prescribing among new doctors in their Foundation Year 1 (FY1) stage is common, and can result in the underuse of effective medicines, adverse drug reactions and medication errors.

Up to a quarter of litigation claims in the NHS stem from medication errors (Source: An Organisation of Memory, 2000, London: The Stationery Office),therefore emphasis has now been placed towards ensuring that patients in hospitals have safe care by improving the knowledge and skills required for safe prescribing in FY1 doctors.

"Medical schools educate on the theoretical side of medicine, but actual prescribing in practice is very difficult'," says Dr Philip Thomas, a Junior Doctor in the West Midlands.

The SCRIPT (Standard Computerised Revalidation Instrument for Prescribing and Therapeutics) project which was funded by the West Midlands Strategic Health Authority (SHA) has brought together a team of experts from Aston University (UK) and Birmingham and Warwick Medical Schools (UK) to create the innovative, e-learning toolkit in response to the challenges of safe prescribing.

SCRIPT will introduce 38 key modules that will reflect the basic needs of FY1 doctors (the complete list can be found at www.aston.ac.uk/script). This will enable doctors to undertake basic revision and reach minimum standards in prescribing and enable them to build upon their existing skills in safe and rational prescribing.

The Toolkit will be launched in June 2011, but with staggered 'go live' dates throughout the year. Five modules will go live by the end of September 2010 -- Prescription Documentation, Medication Errors, Allergy and Anaphylaxis, Peri-operative Prescribing and Dangerous Drugs.

Professor John Marriott, who is the SCRIPT Programme Manager at Aston University in Birmingham (UK), said; "Prescribing skills have been identified as a skill set of FY1 doctors that needs re-enforcement since pressures on junior doctor learning are immense, sub-optimal prescribing can impose a burden on public health and jeopardise patient safety. Improving the prescribing skills of doctors during their formative professional years will improve patient safety in the short term, and may bring long-term benefits in safe and rational prescribing.

"Through our expert working groups, and in collaboration with our content authors, the SCRIPT team will establish the level of knowledge required about commonly used and important drugs. Many e-learning packages aim to develop specific formularies in response to the perceived need for knowledge about a set number of drugs. We are not planning an electronic formulary, as it would not be transferable throughout the region owing to local variations in practice and specific hospital formularies. We will therefore provide for indexing of drugs and tagging of potentially dangerous drugs within the design of the SCRIPT toolkit.

"Experience of prescribing and medicines management in the acute hospital sector is a strength of this project team. We have assembled key clinical pharmacists and pharmacologists from local Trusts such as Sandwell and West Birmingham NHS Trust, Heart of England NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trusts, Dudley Group of Hospitals NHS Foundation Trust, University Hospitals Coventry and Warwickshire, and George Eliot Hospital NHS Trust, to proactively drive the strategic direction, content, and editing of all electronic material."

Dr Jamie Coleman, who is a Senior Clinical Lecturer in Clinical Pharmacology & Medical Education at the University of Birmingham and an Honorary Consultant Physician said; "Education does not stop at medical schools. We are keen to promote good practice among junior doctors by working with NHS West Midlands and academia to provide relevant practical training as an online simulation through this new SCRIPT toolkit."