Course structure

The ‘Educational Pharmacist’ will organise a programme and facilitate teaching sessions. Each session will have a specific clinical theme.

He/she will prepare paper-based clinical scenarios in conjunction with clinical staff relevant to the topic for each particular session (e.g. consultant or specialist pharmacists in each relevant specialty). The sessions will map to the Foundation Years Curriculum. In each session, trainees will be required to commit pen to paper and write out ‘dummy’ prescriptions for the simulated patient scenarios.

The programme will be non-threatening and held in protected time. There will be 15 sessions for FY1s, and 15 for FY2s. Trainee and pre-registration pharmacists will learn alongside them.

The Pharmacist will also assess prescribing by individual doctors on the wards and give one-to-one feedback on selected charts of real patients as part of a mentoring scheme. He/she will also observe pharmacists on the wards. He/she will also maintain competence in day to day pharmacy practice.

Structure of typical training sessions

Sessions will address specific clinical problems as set out in the topic list and be approximately one to one and a half hours long – in three sections.

  • Whole Group Session: to describe how to prescribe properly and the common pitfalls leading to poor prescribing. Some flexibility will allow time to address dispensers and prescribers concerns.
  • Small group work: in which doctors and pharmacists will have semi-structured workshops to learn together about selected conditions based on structured clinical scenarios. Medical trainees explain to pharmacists issues about assessment and diagnosis, whilst pharmacists help medics make appropriate choices of drugs and write drugs charts properly.
  • Practical Prescribing Assessment: at the end where trainees write ‘dummy’ prescriptions for two to three patients described in short written case histories covered that day. These are ‘marked’ and feedback given at the next session.

Foundation Doctors in the West Midlands Deanery complete a 40-module e-learning package called ‘SCRIPT’ (Standard Computerised Revalidation Instrument for Prescribing and Therapeutics). This provides an excellent theoretical knowledge for the principles of prescribing, building upon undergraduate learning.

We will link our programme where possible with SCRIPT modules. Trainees will be expected to complete relevant module(s) before each teaching session so that new knowledge can be put into practice immediately.

Responsibility for the programme will lie jointly with the Head of Pharmacy, Head of Medical Education in the Trust and ultimately the CEO.

Link to SCRIPT modules

The SCRIPT Prescribing Education & Assessment Programme: www.safeprescriber.org

Introduction

SCRIPT is an electronic training programme, with assessment built in, designed to support Foundation doctors in becoming completely safe prescribers. The West Midlands Deanery requires that specified numbers of the modules are undertaken in year 1 and year 2 of the Foundation Programme. Each module takes 30 to 90 minutes to complete and successfully passing the built in assessment results in the production of a certificate to confirm the pass, which should be logged in the trainee’s Educational Portfolio.

Numbers Required

The Deanery requires 16 modules to be completed during Foundation year 1 and a further 15 in Foundation year 2. These may be undertaken in trainees’ private time or during ‘protected teaching time’ arranged by the clinical tutor of the trust in which the trainee is working.

Links with Foundation Curriculum Outcomes

Foundation programme outcomes and competencies

The Foundation Programme Curriculum 2012 sets out the framework for educational progression that will support the first two years of professional development following graduation from medical school.

Good clinical care

Section 7.5 – Safe prescribing

F1 outcomes

  • Prescribes medicines, blood products and fluids accurately and unambiguously and regularly reviews drug chart
  • Prescribes appropriately for common important presentations e.g. exacerbation of chronic obstructive pulmonary disease, congestive cardiac failure, pain

F2 outcomes (in addition to F1)

  • Anticipates changes in medication required on admission, during stay, at discharge and in outpatients
  • Use strategies other than prescribing to manage patients’ symptoms

Competences

  • Takes an accurate drug history, including self-medication, use of herbal products and enquiry about allergic and other adverse reactions.
  • Discusses drug treatment and administration, including unwanted effects and interactions, with patients and, when appropriate, carers, using aids such as patient information leaflets.
  • Prescribes drugs and treatments appropriately, clearly and unambiguously in accordance with Good Practice in prescribing medicines (GMC, 2008) (for an F1 in hospital and for F2 for community, including on FP10).
  • Understands and applies the principles of safe prescribing for different patient groups including children, women of child-bearing potential, pregnant women.
  • Considers the effect of hepato-renal dysfunction on pharmacokinetics.
  • Recognises the potential hazards related to different routes of drug administration (e.g. oral, intramuscular, intravenous, intrathecal).
  • Understands the limitations of F1 doctors prescribing and transcribing prescriptions for cytotoxic drugs.
  • Uses the British National Formulary (BNF) (and BNF for Children where appropriate), plus pharmacy and computer-based prescribing-decision support to access information about drug treatments, including drug interactions.
  • Performs dosage calculations accurately and verifies that the dose calculated is of the right order.
  • Works closely with pharmacists and more experienced prescribers to ensure accurate, safe and effective error-free prescribing, whilst recognising that the legal responsibility remains with the prescriber.
  • Transfers previous prescriptions accurately and appropriately when patients move between different areas.
  • Chooses appropriate intravenous fluids as vehicles for intravenous drugs and calculates the correct volume and flow rate.
  • Monitors therapeutic effects and adjusts treatments and dosages appropriately.
  • Recognises and initiates action for common adverse effects of drugs and communicates these to patients, including potential effects on work and driving.
  • Prescribes oxygen appropriately including to patients with the risk of carbon dioxide retention.
  • Prescribes controlled drugs within appropriate legal framework in hospital and understands the management and prescribing of controlled drugs in the community.
  • Understands the importance of security issues in respect of prescriptions. Notifies regulatory agencies of reportable adverse drug reactions to medicines and blood products.
  • Demonstrates awareness of, and follows guidelines on, safe use of blood and blood products, including awareness of religious/cultural beliefs.
  • Prescribes blood products appropriately and recognises transfusion reactions Seeks evidence about appropriateness and effectiveness of therapies in making prescribing decisions, including evidence which may be available in National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and local guidelines.
  • Understands the importance of summaries of product characteristics and implications of off-label and unlicensed use of medicinal products. Understands and is aware of critical medication which needs to be administered urgently as per National Patient Safety Agency (NPSA) guidelines.
  • Relates prescribing activity to available prescribing guidelines/audit data e.g. antibiotic usage.
  • Follows the guidance in Good Medical Practice in relation to self-prescribing and prescribing for friends and family. Completes local prescribing learning as required.
  • Anticipates, prevents and manages adverse drug and transfusion reactions, and understands how and when to report suspected adverse reactions to the Medicines and Healthcare product Regulatory Agency (MHRA).
  • Deals with complex situations including drug contra-indications.
  • Is able to work productively with hospital and community pharmacists in managing medicines.
  • Seeks appropriate advice with prescribing including medication for discharge.