Background Patients with rheumatic diseases occupy over 50,000 bed days annually in the National Health Service. Adverse drug events are major causes of harm to patients in hospitals and are associated with prolonged length of stay with higher costs. National Patient Safety Agency has issued several alerts regarding DMARDs and Methotrexate overdose remains a “never event”. Prescribing medications, including DMARDs for rheumatology patients, is one of the chief responsibilities of junior doctors.
Objectives We undertook a pilot survey of junior doctors and medical students to understand their level of prescribing confidence with an aim to develop a teaching program.
Methods Following a focus group discussion based on NPSA safety alerts and BSR DMARD monitoring guidelines, ten items were unanimously identified as core knowledge required for safe prescribing. A questionnaire was created based on these elements. Junior doctors and final year medical students were surveyed at our academic institution. Replies were compiled to ascertain their understanding of safe prescribing and troubleshooting DMARD related issues.
Results 41 junior doctors of all grades and nine medical students contributed to the survey. Only 6/50 (12%) felt confident in prescribing whereas 16/50 (32%) had borderline confidence and remaining 56% felt it was beyond their expertise. Of the 41 junior doctors, 19 (46%) had never even prescribed DMARD despite encountering such patients on the wards. Principal reasons for this included lack of confidence (40%), paucity of knowledge (15%) and no formal education (32%). Questions pertaining to safe prescribing were confidently answered by only 4/50 (8%) participants.
Conclusions To our knowledge, this is the first survey to demonstrate that there are serious shortcomings in junior doctors' understanding of safe DMARD prescribing. Inadequate training and hence poor confidence among front line medical staff remains the main cause of this issue. Despite consistent evidence suggesting that rheumatology teaching in medical schools has historically been poor and active measures taken in recent past to identify better ways to address the issues, this study highlights major knowledge gaps among everyday and future prescribers. Focused strategy and better training of junior doctors, both during and after graduation, are pivotal to providing better care for patients prescribed DMARDs during inpatient hospital stay.
Disclosure of Interest None declared