Pre-prescribing: a safe way to learn at work?

BACKGROUND: The General Medical Council mandates that UK medical graduates must be able to 'prescribe drugs safely, effectively and economically'. However, data from three UK medical schools show that graduates are poorly prepared for prescribing, and a recent study detected a prescribing error rate of 8.4 per cent amongst foundation year 1 doctors. CONTEXT: This study took place in the National Health Service (NHS) Fife where, in common with all health boards in the UK, medical students are not permitted to prescribe. University of Edinburgh final-year medical student volunteers took part in the study. INNOVATION: Medical, pharmacy and nursing staff collaborated to design and implement a controlled process (pre-prescribing) that allows medical students to write instructions on in-patient drug charts, and requires a doctor's countersignature before drugs are dispensed. Key features of the pre-prescribing protocol include fluorescent stickers for drug charts, bookmark aide-memoires to guide countersigning and ward-based information sheets. Twelve final-year medical students wrote 586 pre-prescriptions, and no adverse events were reported. IMPLICATIONS: This study demonstrates the successful small-scale implementation of pre-prescribing. Initial data regarding the safety of the process is positive, but further evaluation is required to reassure all that the risk of adverse events is minimal. The project is to be expanded throughout South East Scotland with a view to all units providing the opportunity for pre-prescribing during the first student assistantships in March 2012. The longer-term goal is to set-up safe processes that will support medical students undertaking pre-prescribing throughout most of their final year. © Blackwell Publishing Ltd 2012.