A  mul&disciplinary  review  of  the  teaching  and  assessment  of  prescribing:  how  do  professions  perform?  

Lynda  Cardiff1,  Lisa  M  Nissen1,  Paul  BenneD2,  Lloyd  Reed2,  Vivienne  TippeD3,  Peter  Horrocks3,  Andrew  Carkeet4,    Vincent  Chan5,  Sonya  Osborne6,  David  Lim3  

1-­‐School  of  Clinical  Sciences  QUT,  2-­‐Podiatry  Discipline  QUT,  3-­‐Paramedic  Science  Discipline  QUT,  4-­‐Optometry  Discipline  QUT,  5-­‐Pharmacy  Discipline  QUT,    6-­‐School  of  Nursing  QUT

Introduc&on    Prescribing   is   a   complex   task,   requiring   specific   knowledge   and   skills,   combined   with   effec;ve,   context-­‐specific   clinical   reasoning.     Errors   associated   with  prescribing  result  in  significant  morbidity  and  mortality.    Systema;c  reviews  indicate  medical  prescribing  errors  range  from  7%  to  10.3%  of  medica;on  orders1.  For  both   established   and   emerging   professions   with   prescribing   rights,   there   is   a   clear   need   to   ensure   graduates   have   well   defined   prescribing   skills,   to   enable  competent  prescribing.    Essen;al  to  this  outcome  is  the  applica;on  of  comprehensive,  evidence-­‐based  assessment  methods  that  effec;vely  assess  these  skills.   1.  Dornan  T  et  al.,  An  in  depth  inves5ga5on  into  causes  of  prescribing  errors  by  founda5on  trainees  in  rela5on  to  their  medical  educa5on.  EQUIP  study.  

Prescribing  is  comprehensively  taught  and  assessed  across  the  five  non-­‐medical  professions  studied.    Iden;fied  gaps  in  the  curriculum  serve  as  a  prompt  for   improvement   in  this  area.  Gaps  exist   in  understanding  what  cons;tutes  op;mal  assessment  of  a  diverse  health  workforce   in  rela;on  to  prescribing  medicine.   Currently,   there   is   no   single   validated   and   reliable   method   for   assessing   all   elements   of   prescribing   performance.   This   project   highlights  difficul;es  in  the  prescribing  assessment  process,  par;cularly  in  the  work  integrated  learning  environment.  In  the  interests  of  pa;ent  safety,  there  remains  a  compelling  need  to  develop  comprehensive  methods  to  assess  the  prescribing  competence  of  students  across  disciplines  in  both  the  university  and  work  integrated  learning  environments.  

The  NPS  Prescribing  Competencies  Framework  (PCF)2  was  used  as  the  accepted  standard  for  prescribing  skills,  knowledge  and  behaviours.  Review  of  the  curriculum  for  five  non-­‐medical  prescribing  professions  was  undertaken  to  iden;fy  whether  the  prescribing  elements  as  ar;culated  in  the  PCF  were  taught  and  assessed.      2.  NPS:  BeGer  Choices  BeGer  Health,  Competencies  required  to  prescribe  medicines:  puKng  quality  use  of  medicines  into  prac5ce.  2012,  Na5onal  Prescribing  Service  Limited:  Sydney.    

Method  

For  each  profession:  §  The  context  in  which  prescribing  occurs  was  

reviewed    §  A  detailed  mapping  of  the  curriculum  was  

undertaken  to  iden;fy  where  and  how  prescribing  skills  and  knowledge  are  currently  taught  

§  The  methods  used  to  teach  and  assess  prescribing  skills  and  knowledge  were  iden;fied  

§  Areas  for  improvement  in  the  teaching  and/or  assessment  of  prescribing  were  iden;fied  

Conclusion  

Results  

Clinical Lecture Tutorial Case Study SDR

Podiatry

Paramedicine

Pharmacy

Optometry

Nurse Practitioner

Most  Frequent  Methods  Employed  to  Teach  Prescribing  

SDR = Self directed reading/research

Most  frequent  Methods  Employed  to  Assess  Prescribing  

Clinical Appraisal

Case Study OSCE Written Exam

Oral Exam Written Reflection

Podiatry

Paramedicine

Pharmacy

Optometry

Nurse Practitioner

Challenges  §  Applying  context  to  prescribing  across  

professions  (acute  care  paramedic  vs  pharmacist  vs  podiatric  surgeon)  

§  Iden&fica&on  of  ffec&ve  and  robust  assessment  of  prescribing  in  the  work  integrated  learning  environment  which  is  suscep&ble  to  many  uncontrollable  factors  (e.g.  skills  and  knowledge  of  supervisor)  

§  Determina;on  of  whether  high  level  assessment  translates  to  safe  and  effec;ve  prescribing  in  prac;ce  

Discipline)Mapping:))Bachelor)of)Pharmacy)Element)H2.5)Collaborates)with)other)health)professionals)to)achieve)optimal)health)outcomes)for)the)person)

Performance)Criteria) Teaching) Teaching)Method/s)

Assessment) Assessment)Method/s)

H2.5.1&Engages&in&open,&interactive&discussions&with&other&health&professionals&involved&in&caring&for&the&person&

CSB430)Pharmacy)Practice)1&Available&written&literature&regarding&commonly&employed&medicines&and&strategies;&specific&counselling&points&for&medicines&and&non@medicine&therapies.)

L.GW& CSB430)Pharmacy)Practice)1&Oral&examination.)

OE&

CSB440)Pharmacy)Practice)2&Understanding&of&the&pharmacology,&indications,&potential&contraindications,&precautions&and&specific&counselling&points&for&commonly&used&medicines&for&cardiovascular,&respiratory,&thyroid&diseases;&eczema;&contraception.&&Provision&of&appropriate&written&and&verbal&advice.)

L.GW.CLP& CSB440)Pharmacy)Practice)2&Oral&examinations;&case&presentations&completed&during&placement;&preceptor&assessment&of&counselling&skills&during&placement.)

OE.CP.CPA&

CSB450)Pharmacy)Practice)3&Specific&counselling&and&questioning&requirements&for&medicines&used&for&severe&pain,&anxiety,&dementia,&Parkinson’s&disease,&depression,&diabetes,&epilepsy,&sleep&disorders,&glaucoma,&migraine.&&Understanding&of&addiction&and&its&management.)

L.GW.CLP& CSB450)Pharmacy)Practice)3&Oral&examinations;&case&presentations&completed&during&placement;&preceptor&assessment&of&counselling&skills&during&placement.)

OE.CP.CPA&

!