When did you first introduce the innovation?
Less than 12 months ago
Please describe the innovation you have developed
An inter-professional, expert advisory panel was convened to design, pilot and evaluate an inter-professional masterclass with trainee prescribers from medicine, nursing and allied health professionals and pharmacy. The expert advisory panel comprised of four members; one doctor, one nurse and two pharmacists with expertise in prescribing, education and simulated teaching. Medical students learn to prescribe at an undergraduate level while non-medical prescribers and pharmacist prescribers are able to gain extra skills in prescribing post-registration.
Three cases, which would commonly be encountered in practice and at the level of a foundation doctor or non-medical prescriber, were designed; one sepsis, one polypharmacy and one community-based case
Model answers using local and national guidelines were prepared. The sepsis and community scenario cases required a history to be taken from a simulated patient, a suitable diagnosis to be decided upon and a prescribing management plan formed and executed. The third, a polypharmacy case, was designed as a paper-based scenario and focused on developing skills in medication review, recognition of adverse drug reactions and BNF/local formulary navigation. Each scenario lasted 45 minutes, was facilitated by a member of the panel and one participant from each of the three professions formed the delegate groups. On completion of each scenario, the facilitator checked the prescribing decisions made against the model answers and gave feedback on participant performance. Students and simulated patients were also encouraged to feedback on their perceptions of the scenario.
To verify accuracy, relevance and timing, the scenarios were initially tested with a cohort of non-medical prescribing students. Ethical approval was sought and approved by Edinburgh Napier University and the University of Edinburgh Medicine and Veterinary Medicine Student Advisory Committee. NHS research ethics approval was not necessary.
What prompted you to develop this innovation?
Prescribing errors cause significant patient morbidity and mortality. Current legislation allows prescribing by different health professions. Inter-professional collaboration and learning may result in safer prescribing practice. This study aimed to develop, pilot and test the feasibility of a simulated inter-professional prescribing masterclasses for non-medical prescribing students, medical students and pharmacists.
In your view, what is it about this innovation that makes it different/important?
Prescribing is a complex process which frequently involves collaboration with different health care professionals in order to make safe, effective, and evidence-based prescribing decisions. and supervision.
Simulation in clinical education has been shown to be beneficial for the development of clinical practice and skills, permitting the learner to develop skills in a controlled and safe environment(1-3). This has recently been demonstrated in a large scale study with nurse and doctor trainee prescribers (4). However, as far as the authors are aware, there is no published evidence that this type of learning occurs between nurse and pharmacist non-medical prescribing students and medical students, nor is there any evidence of the value of this type of education.
The aim was to develop, pilot and test the feasibility of a simulated inter-professional prescribing masterclass for medical students and nurse and pharmacist non-medical prescribing students.
1. Shin S, Park J-H, Kim J-H. Effectiveness of patient simulation in nursing education: meta-analysis. Nurse Education Today. 2015;35(1):176-82.
2. Evans LV, Crimmins AC, Bonz JW, Gusberg RJ, Tsyrulnik A, Dziura JD, et al. A comprehensive, simulation-based approach to teaching clinical skills: the medical students’ perspective. The Yale Journal Of Biology And Medicine. 2014;87(4):575-81.
3. Woodfield G, O’Sullivan M, Haddington N, Stanton A. Using simulation for prescribing: an evaluation. The Clinical Teacher. 2014;11(1):24-8.
4. Watters C, Reedy G, Ross A, Morgan NJ, Handslip R, Jaye P. Does interprofessional simulation increase self-efficacy: a comparative study. BMJ Open. 2015;5(1):e005472-e.
To what extent does your innovation make use of existing approaches, resources or technologies?
Currently in pharmacy, medical and non medical prescribing programmes uniprofessional simulation is used frequently. This was to explore the feasiblity of combining the programmes simulation work.
To what degree has this innovation led to changes in education or clinical practice?
There are plans to submit a grant proposal to develop the innovation further. this will involve a study that test the effect of interprofessional prescribing simulation compared to uniprofessional prescribing simulation.
What evidence do you have of the impact of the innovation?
A three-scenario, simulated patient session was designed and implemented by an expert panel. Medical students, non-medical prescribing students and pharmacists worked together to formulate and implement evidence-based prescriptions. The Readiness for Inter-professional Learning Score (RIPLS) and a self-efficacy score was administered to the students and the Trust in Physician Score to the simulated patients. A focus group was convened after the intervention and the results thematically analysed. Overall, the RIPLS and self-efficacy scores increased. Pharmacists showed the highest rating in the Trust in Physician score. Focus group analysis suggested that the intervention was viewed as a positive educational experience.
To what degree has the innovation been disseminated in your organisation or elsewhere?
Publication in the Scottish Medical Journal (in press)
Presentation at conference July 2015.
Please provide details of any plans you have to disseminate the innovation in the future.
We would like to carry out a larger study and we are seeking out sources of funding at present. A study of this nature meets many educational and clinical agendas including interprofessional collaboration and patient safety. Furthermore dissemination of result sof a wider project would have national and international interest particularly because the UK has the most liberal non medical-prescribing legislation in the world.