Abstract
Context Medical interns find prescribing challenging and lack readiness
when commencing work. Error rates remain high despite education,
supervision and pharmacists’ contributions. Feedback on prescribing may
improve performance. Yet, work-based prescribing feedback focuses on
rectifying errors. We aimed to improve prescribing using a
theory-informed feedback intervention. Methods In this mixed methods
study, we designed and implemented a feedback intervention, informed by
Feedback-Mark 2 Theory. Interns commencing internal medicine terms
engaged in the intervention. Prescribing performance was evaluated by
comparing the number of errors per order of at least 30 medication
orders per prescriber from weeks 1-3 (pre/baseline) and weeks 8-9
(post-intervention). Baseline interns’ audit findings were analysed and
discussed during individualised feedback sessions with either a clinical
pharmacologist (Site 1) or pharmacist educator (Site 2). Results
Prescribing by 88 interns, across two hospitals over five 10 week terms,
was analysed. Following the intervention, there was a significant
reduction in prescribing errors (p<0.001) from 1598 errors in
2750 initial orders (median [IQR] 0.48 [0.35-0.67] errors per
order) before and 1113 errors in 2694 orders (median [IQR] 0.30
[0.17-0.50] errors per order) after. There was no reduction in
initial error rate over the five terms. Conclusions Our theory-informed
feedback intervention contributed to a significant reduction in interns’
prescribing errors. This study opens up new strategies for improving
prescribing safety through feedback interventions. The results emphasise
that learner centred and improvement-focussed feedback with an agreed
plan could significantly improve prescribing safety an outcome which
supervision, education and pharmacist interventions had not delivered.