Download Abstract – eDrug:Malawi – essential training in safe prescribing

e-Drug:Malawi – essential training in safe prescribing
Louisa Alfazema1, David Dewhurst2 and Ross Ward2
1
Department of Pharmacy, College of Medicine, University of Malawi Private Bag 360, Chichiri
Blantyre 3, Malawi
2
Learning Technology, College of Medicine & Veterinary Medicine, University of Edinburgh, 15
George Square, Edinburgh EH8 9XD, UK
Training in safe prescribing is an essential component in any medical degree course. This
is certainly true in the UK where it has been suggested that 10% of hospital prescriptions
contained errors and that senior doctors were almost as frequently culpable as those who
had recently graduated [Dornan, et al 2009)], avoidable adverse drug reactions are a
frequent cause of consultations in primary care, and admission to hospital and increased
length of hospital stay (Maxwell, et al 2011). The reasons are complex but one possible
explanation is that the education and training delivered at medical schools (providing
them with books of reference information (e.g. national or local formularies) is no longer
fit for purpose (Maxwell, et al 2011) and there is evidence to suggest that delivery of
information could be improved (Jha, et al, 2008). In developing countries, such as
Malawi, data relating to the impact of poor prescribing on patient safety and clinical
outcomes is not as available but one study in Malawi has indicated that there are similar
deficiencies in prescribing safety (Sosola, 2007).
As part of a long-term and ongoing collaboration between the Medical Schools at the
Universities of Malawi and Edinburgh, UK we have developed an electronic resource,
available online, to support teaching of basic and clinical pharmacology and in particular
safe prescribing. The resource (eDrug:Malawi) has been adapted from a similar resource
(e-Drug:Edinburgh) originally developed to support the Edinburgh medical curriculum in
2005 and which has been rated highly by students (Maxwell, et al 2006).
e-Drug:Edinburgh is an electronic formulary of around 180 core drugs (sometimes
termed class exemplars) the details of which are considered to be essential knowledge for
UK medical students. Each has been selected by clinical pharmacology teaching staff
because it is in common usage in the UK, is used to treat common illnesses, is
representative of an important drug class, and is a drug that a recently qualified doctor
might be expected to identify as an appropriate treatment for a particular patient (or
prescribe under the direction of a senior doctor). The list of drugs is based on the drug
classification used by the British National Formulary (BNF) but differs from the eBNF in
listing only the core drugs that are mentioned in lectures or related teaching. These are
the core, exemplar or key drugs whose actions medical students are expected to know
about, in the exam room and on the wards/clinics. In contrast to the eBNF, it also
provides concise information about the mechanism of action of the exemplar drugs, and
has live links to associated learning materials including PowerPoint presentations,
supplementary lecture notes (as MSWord/pdf documents), and relevant computerassisted learning resources.
The formulary is organised into the major body systems on which the medicines act (e.g.
central nervous system, cardiovascular system) and many of these are organised into subcategories (such as angina, chronic heart failure, hypertension). Each of those subcategories will then list a number of drugs commonly used in the UK for treatment of that
condition (e.g. for angina six drugs are listed: atenolol, glyceryl trinitrate, dilitiazem,
nicorandil, isosorbide). Each drug entry contains concise, quality-assured information
about structure, main actions, contraindications, and mechanism of action. There are links
to quality-assured, third-party information on websites, such as Wikipedia, Answers.com,
bnf.org, and uniquely to other University of Edinburgh teaching resources such as lecture
PowerPoints from the curriculum where that particular medicine is taught, selfassessment quizzes and locally-developed online teaching resources.
The online formulary is searchable and users can browse by drug name, and/or use an
alphabetical (A-Z) list, or search by keyword. Students are able to bookmark pages and
add annotations e.g. notes relevant to a particular medicine gleaned from their own
research, making the resource personalizable (My Formulary).
eDrug:Malawi has the same format but the drug list has been modified to contain those
drugs most regularly prescribed in Malawi. Of the 180 in e-Drug:Edinburgh,
approximately 47 have been omitted and over 30 added. Most of the additions reflect the
much more common treatment of tropical infectious diseases in Malawi such as malaria,
HIV, yellow fever. Certain drug categories such as “anti-obesity” and “drug-dependence’
from e-Drug:Edinburgh have been removed as treatments for these conditions is rare in
Malawi.
Thus e-Drug:Malawi comprises a set of medicines relevant to treatment protocols and
drug availability in Malawi and is based on the Malawian National Formulary published
by the Malawian Essential Drugs Programme and the Ministry of Health. Some of these
drugs will be the same as those used in the UK but many will be different making this a
relevant resource for Malawian doctors, pharmacists, nurses and other healthcare
professionals.
eDrug:Malawi will be delivered via the existing Curriculum Management System
(CMS)/Virtual Learning Environment (VLE) systems in the College of Medicine and
Kamuzu College of Nursing (KCN), Malawi allowing student access 24/7. These VLEs
have been developed by IT staff in Malawi working closely with IT staff from Edinburgh
and are now run and managed on local servers and delivered via high-speed intranets.
Students have good access through dedicated computer facilities in both the College of
Medicine and KCN and can also access the same resources, via the Internet, from
personal PCs. Clinical pharmacologists ensure that the information is kept up to date, and
administrative rights to the system enable them to edit existing information and add new
drugs as required.
Safe prescribing is not just about knowledge of medicines but also about the ability to
competently prescribe correct doses to a wide variety of patients. These would include
calculating doses for different routes of administration, making correct dilutions,
calculating doses for patients of varying body weight, gender, age and medical condition.
Thus it is anticipated that future developments of eDrug:Malawi will provide a selfassessment resource enabling doctors and other prescribing professionals to work through
a series of patient scenarios, often involving dose calculations, testing these
competencies. It is also anticipated that ‘specialist’ formularies will be provided for other
health care professionals in Malawi such as nurses and clinical officers
Acknowledgements
The development of e-drug: Malawi was supported by a grant from the Scottish
Government International Development Fund.
Ms. Nettie Dzabala and Mr. AG Sosola for providing support to develop e-drug:Malawi
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