Standardised Computerised Revalidation Instrument for Prescribing and Therapeutics (SCRIPT)
HEE YH introduced SCRIPT to Foundation training in August 2015. Trainees are asked to complete ten modules in F1 and a further ten in F2, where possible, as best practice.
There are five suggested modules per year and 5 can be selected by the trainee, preferably related to the specialities being completed in the trust.
Completion of these modules has been added to the YHFS Best Practice Checklist.
It is estimated that one in ten patients is harmed while receiving hospital care. Medication errors can be defined as “a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient”1
Medication prescribing errors are those that have specifically occurred during the prescribing process, where there is a failure to order the right drug at the right dose at the right frequency for the right patient. In the UK, medication errors account for 10–20% of all adverse events in the National Health Service (NHS) and preventable harm from medicines is estimated to cost more than £750million each year. A quarter of litigation claims in the NHS also stem from such errors.
In the UK, the majority of prescribing in hospitals is undertaken by Foundation trainee doctors in the first and second year of foundation training. Given the rate of errors, in 2009, the General Medical Council (GMC) commissioned a study to determine the causes of prescribing errors made by Foundation trainee doctors with the aim that this could inform evidence-based recommendations to improve patient safety and define a future research agenda. The EQUIP study2 found that the rate of error varied depending on the grade of the doctor, but that year 1 and year 2 trainee doctors prescribed with an error rate of 8% and 10% respectively. The findings of this study highlighted serious weaknesses in existing educational approaches indicating that many newly qualified doctors are poorly prepared for prescribing. The authors found that poor prescribing was widespread and results in the underuse of effective medicines; avoidable adverse drug reactions and medication errors. The study made three key recommendations:
- Education in practical prescribing should be part of foundation year one education.
- Foundation trainee doctors should be given explicit feedback regarding their prescribing practice during foundation education.
- Help-seeking and feedback-seeking behaviours should be encouraged in workplace education and appraisal.
As a result of the EQUIP study, in 2010 Health Education West Midlands and the Humber (or then the Strategic Health Authority) commissioned the Universities of Birmingham, Warwick and Keele to develop an online eLearning programme to improve prescribing competency of trainee doctors. The overall aims of the project were to:
- Encourage safe, effective, and rational prescribing by developing learning modules that reflect current prescribing practice in the NHS.
- Improve the prescribing knowledge and skills of newly qualified doctors during the formative years of their professional development, in order to reduce medication errors and improve patient safety.
SCRIPT was created in 2011 by a team of clinical pharmacists and clinical pharmacologists working in both education and healthcare.
1 Ferner RE, Aronson JK. Clarification of Terminology in Medication Errors: Definitions and Classification. Drug Safety. 2006;29(11):1011-22.
2 Dornan T, Ashcroft D, Heathfield H, Lewis P, Taylor D, Tully MP, et al. An in depth investigation into causes of prescribing errors by foundation
Trainees should register at the following HEE YH specific SCRIPT link: http://heyh3.safeprescriber.org
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