What are we trying to achieve?
Junior doctors are responsible for the majority of prescribing in hospitals. Prescribing errors account for a substantial proportion of medication errors and can cause significant harm to patients. Studies of prescribing errors suggest that knowledge-based errors are important and could potentially be addressed by educational interventions focused on medical students and junior doctors.
The aim of these e-Learning courses is to use an online education tool to improve prescribing and increase the use of evidence based medicine by junior doctors.
- Ross S, Bond C, Rothnie H, Thomas S, Macleod MJ. What is the scale of prescribing errors committed by junior doctors? A systematic review. Br J Clin Pharmacol.2009 June; 67(6): 629-640
What have we done?
The development of the Safe Use of Medicines e-Learning courses began in 2006. At this time, Waitemata DHB was the first in the country to offer e-Learning to junior doctors. There are now twelve courses uploaded to the e-Learning Courses for Health Organisations (e-CHO) platform, and another eight courses have been approved.
These courses are written by the QUM team in consultation with clinical teams, then reviewed and approved by relevant consultants and departments, and uploaded onto the e-CHO site. Clinical governance of the QUM team is provided by a Steering Group which includes members from primary and secondary care, and a consumer representative.
Safe Use of Medicines module on e-CHO site
Live on e-CHO
- The Adult Medication Chart
- Medication History
- Heart Failure Medicines
- Prescribing in Older Adults
- Hyoscine (for radiology technicians)
- Paediatric/neonatal gentamicin
- Pharmacological management of pain
- Dementia, Delirium, and Depression
- Management of hyperkalaemia
- Medicine dosing in renal disease
- Management of hypoglycaemia
- DKA (Diabetic Ketoacidosis) and GIK (Glucose Insulin Potassium) infusions
- Management of psychosis
- Pyxis OR Discharge summary
The e-Learning courses are matched to the relevant junior doctor teaching sessions during the year. The QUM team liaises with our Medical Education and Training Unit to make sure the junior doctors are reminded to complete the courses prior to oral teaching sessions. An online quiz is attached to each of the courses and on completion the users receive a certificate which they can add to their learning portfolios.
The courses are frequently used by nurses, pharmacists, midwives and dietitians, so the information is tailored to suit the needs of these health professionals too.
Screen shots from the Medication History course
The courses have been widely offered to and are used by several other DHBs, Southern Cross Hospitals and the Goodfellow Unit (a provider of continuing medical education to general practitioners and other professionals working in primary health care).
Pharmacological Management of Pain
In 2012-2013, the QUM team developed a Pharmacological Management of Pain e-learning course. The need for such a course was identified by our Medication Safety Group and the Quality Team.
A consistent theme of medication incidents and complaints is inadequate pain management, and opioids such as morphine, fentanyl and oxycodone, are one of the most frequent causes of serious harm to patients. This is consistent with international studies that have shown opioids are still among the most frequent high-risk medicines most likely to cause significant harm to the patient. In addition, our data also shows us that when patients experience side effects of pain-relief medication, we do not manage this well, particularly nausea and constipation caused by opioids.
Our Pain Services Team, Palliative Care Team, Older Adults Service, Pharmacy Department, Quality Team and the QUM team collaborated to develop a pain management e-Learning course for staff titled ‘Pharmacological Management of Pain’. The course offers information for prescribers and nurses to help them best assess and manage pain appropriately with medication. It provides a comprehensive, practical ‘how to guide’ on pain management.
The course compliments the external website created by our pain services (Waitemata Pain Services), which provides useful information, resources and educational material for both patients and healthcare practitioners - www.wps.ac.nz.
Waitemata Pain Services website - www.wps.ac.nz
The course takes approximately 45 minutes to complete. Topics covered include the types of pain, pain terminology, how to assess pain, how to manage pain with opioids and with other analgesics (pain relieving medication), how to refer patients to our Pain Services and Palliative Care Service, how to transfer care to primary care on discharge, and how to prescribe pain relief when the patient is discharged from hospital. In addition, there are a series of case studies that highlight the importance of key messages e.g. taking accurate pain and medication histories before prescribing.
Where to from here?
The QUM is making further modifications to the pharmacological management of pain course, focusing on improving the way the side effects of opioids are managed, including encouraging prescribing of laxatives and anti-emetics (medications to prevent vomiting), and to be on the alert for signs of respiratory depression and sedation. Ongoing development of Safe Use of Medicines e-Learning courses continues.