Download Prescribing and Therapeutics

Prescribing and Therapeutics
Dr L Varadhan
C2017 Meeting – Doctor as Practitioner
1st June 2016
Agenda
• Current teaching offered year-wise in hospitals
• What is expected at the end of academic years
• Broad overview of changes needed
Y3 – What is being done
• Introductory prescribing session – induction
• Y3 pharmacology sessions
– Increased familiarity with drugs in relation to
clinical scenarios
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Block-based teaching
Wrap-up session – include 10 drugs
Sign off – 18 classes of drugs
Handbook changes
Y3 Handbook
MISTIME
Categories
Explanation
Mode of action
Broadly what class
Indications
Common clinical indications, drug of choice,
contraindications
Side-effects
Common expected side effects; major adverse reactions
Therapeutic evaluation
In context of the medical issue (stop/start/ withhold/
reduce/ continue), renal and hepatic function, planning for
pregnancy, etc.
Interactions
With other used drugs, affect on metabolism
Monitoring
If required; and how; for drug levels; for side effects
Education
Patient information, timing, dietary changes, monitoring,
alcohol
Y3 Handbook
Y3 Handbook
Expectations - At end of Y3
• Familiarity with common classes of drugs
– basic pharmacology profile: name and class of
drug, mechanism of action, indication and
contraindications
• Taking a good and comprehensive drug history
– Including alternative and OTC medications
• Approach a drug chart and able to identify the
drugs, indications, side effects (MISTIME)
• Good familiarity with BNF
Y3 – What needs to be done
• Gap between Y2 and Y5 with respect to drugs and
prescribing
• Pharmacology/therapeutics teaching to be spread across
the year
– CBL tutor training
• CBL – to include discussion on drugs
• Continued familiarity with drugs – all tutors
• Others
– Classes of drugs aligned to BNF criteria
– Consolidation prescribing session as part of Keele Spine
– Antibiotic prescribing session
• SCRIPT access and PSA introduction
Y4
• Y4 prescribing workshops
• Y4 pharmacology session
– Reduce number of cases of therapeutic evaluation
– Slide presentation to give more direction and structure
• Block-specific teaching
– ID team: lecture at Keele Spine on TB and HIV drugs
– O&G: Contraception
• Sign-offs on the log books
Y4 Handbook
Y4 handbook
Expectations at end of Y4
• Familiarity with most of the drugs
– Understand monitoring for effect and side-effect
– Able to identify a wrongly written drug
• Understand interactions of drugs
• Therapeutic evaluation of a drug chart
– Tailored to patient clinical condition
Y4- what needs to be done
• Y5 content to be started in Y4
• CIL presentations to include drug lists
– Tutor and student notes to include this
• Prescribing and therapeutics teaching should
be embedded across the year
– Block Leads and Firm tutors
• Introduction to SCRIPT access
• Limited SOP for Y4 prescribing in hospitals
• Introduction to PSA and Mock exam
Y5 Prescribing
• SOP – Hospital prescribing
– ‘Purple pen’ prescribing
– Student assistantship programme
• SCRIPT access and usage
• Assistantship
– Constituting and administration of drugs
Y5
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Session 1: Prescribing skills
Session 2: Diabetes cases
Session 3: Therapeutic evaluation
Session 4: Delivered in GP
Pharmacist and diabetes nurses involved
Y5
• Induction day at RSUH/SaTH safe prescribing lecture
• GP away day
– Day 1:Death certification & PSA exam
– Day 2: IV fluid prescribing & prescribing – renal and
gentamicin prescribing
• EOL prescribing
– Delivered at hospice
– Orientation to PRN/syringe driver prescribing of EOL meds
Y5 – Pharmacist teaching
• Session 1: Prescribing safety ( at beginning of
the block)
• Session 2: (mid)
– TTO and discharge letters
• Session 3: (mid)
– Heparin/ warfarin and NOAC therapy
Expectations at Y5 completion
• Being a safe and effective prescriber
• Feeling confident to start prescribing as F1
• Broad knowledge of various drugs, therapeutic
issues, guidelines and evidence base
– Assess risk vs benefit
• Pass the PSA exam/summative assessment
Y5 -What needs to be done
• SCRIPT – increase uptake
– Changes to induction session
– ?make mandatory
• PSA in January/February
– Completion of teaching for GP and Hospital Block by
then
– Changes to the presentation materials
– Renal prescribing, therapeutic evaluation, TTO
• Assistantship
– Continued emphasis on drug review and prescribing
– Few sessions with the pharmacist on ward round?
• Uniformity at SaTH and UHNM
General issues
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RIME model
Cross delivery across various sites - hospitals/GPs
Tutor awareness
Signposting of pharmacology and therapeutics
Y3 gap in pharmacology
– Vertical integration in Y3 curriculum
• Y5 duration before PSA