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Over to you

Junior doctors Drs Katherine Taylor, Christina Parfitt and Linze Hamilton want to improve patient safety from the bottom up. They developed patient safety cards to help foundation doctors avoid mistakes

Despite national initiatives, the prevalence of inpatient harm remains as high as 8-10%. Things do continue to go wrong in hospital and in general practice. But is this a surprise? Medical school teaches you the theory of prescribing, but the nitty gritty of medical practice is often learnt on the job. It is well recognised in medicine that this transition is a challenge. You may know that gentamicin can be ototoxic and nephrotoxic, but not necessarily the safest ways to prescribe and monitor levels.

You don’t know what you don’t know until the situation arises, so it makes sense to learn from others that have been in your position.

As new doctors struggling with job pressures and a lack of clinical experience for the first time, it is no wonder that the risk of error increases. The same applies when moving between hospital specialties every three months. Each time we face new challenges and are required to know different information for each department.

The beginnings

Our project began with a group of junior doctors in Nottingham who were asked to give a presentation to new F1s on how to be a good doctor. We decided to focus on how to avoid mistakes that could harm patients. We looked at the most common avoidable errors and developed an informational guide.

From here Junior Doctors Essentials was born (JDE), a junior doctor-led initiative aiming to reduce clinical errors and smooth this transition, thus helping improve patient safety. Our aim is to foster a bottom-up patient safety culture to reduce clinical errors, increase access to local guidelines and improve efficiency.

Launching patient safety cards

One of our initiatives was the development of JDE cards, which are now available to hundreds of foundation doctors. JDE has produced sets-of-ten credit-card sized guides containing concise, up to date and practical information, designed to aid junior doctors during their first few months. The guides are portable and can be clipped to a lanyard or belt.

We place great importance on the cards remaining up-to-date and accurate so they require a continuous audit cycle. Much like any guidelines, the cards are reviewed annually to ensure the information and advice is current. Through audit and feedback we are continually improving the cards to make them as useful and practical as possible.

In practice

Paediatrics, with drug doses calculated in mg/kg and varying frequencies depending on patient age, is a prescription minefield.

The NPSA reviewed paediatric patient safety in 2009 showing that 15-17% of incidents are medication related and 13-17% treatment or procedure related.

Simple things like prescribing fluids become invariably more complicated when your patient is a premature baby. Then there’s that moment when a baby needs to be intubated and you have to prescribe the drugs in a hurry. Not to mention the perils of aminoglycoside prescription and interpretation of therapeutic vs toxic levels.

JDE has expanded the JDE cards to paediatric units across the south west of England and in several units across the country.

Effectiveness

So, the next question is “do they work?” Judging by the positive feedback we’ve had so far, the answer appears to be “yes”. A staggering 83% of junior doctors who used the cards in paediatrics in Severn deanery during 2013 told us they improved their clinical practice, whilst 100% agreed they improved patient safety and 100% said they would recommend us to future cohorts.

We also developed clinical questions to ask juniors both before and after using the cards, aimed at assessing whether they could be said to improve knowledge. The results showed an average 25% improvement in performance in clinical knowledge of topics covered by the cards.

Recently, we took this a step further by looking at incident reports involving patient safety for a local neonatal unit. Our study shows that incidents in areas covered by the cards fell in the group who had access to the JDE cards, compared to the group prior to their introduction. Whilst we cannot attribute all this to the cards alone, they would certainly appear to improve patient safety.

Recognition

We presented at a conference in Melbourne to 119 countries at the International Congress of Paediatrics. Closer to home, our group won an award for our poster at the Patient Safety Congress 2013 in Birmingham, where we presented to over 1000 delegates.

Barriers

It hasn’t all been plain sailing. Finance has been our main barrier. When we first started, we designed, printed, laminated and hole-punched them ourselves. As we have expanded we are printing them professionally to make them wipe clean and user friendly.

Although our cards are non-for-profit, they are sold for £5 a set to cover costs. Hospitals usually use educational funds or charitable funds to pay for them.

Next steps

We would love to see our cards used nationwide and are working to encourage local units to consider whether JDE could help improve patient safety in their area. We are expanding to cover new specialties and are also developing cards for allied healthcare professionals.

Our medium-term goal is to develop a smart phone app which could support the cards and add a new dimension to the way they function.

As juniors, we know first-hand the problems we face on the front line and, year on year, we hope to continue to make life easier for new doctors.

If you have any questions or would like to get involved contact us. Our email is info@jdepaeds.org.uk.

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