Talk to me: exploring how doctors prescribe insulin for children

Alison Bell, Tim Dornan, Richard Conn

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Background Insulin is a dangerous medication and prescribing errors associated with its use can lead to life-threatening con- sequences. Children are a patient group at increased risk of harm when medication errors arise. The success of an insulin prescription can only be assessed in retrospect and many aspects of insulin prescription are uncertain. Holistic prescrib- ing involves not only safely prescribing a medication, but also involving the patient and their parent/carer in the process. An insulin prescription chart structures the task of prescribing but there is a lack of research on its impact on doctors’ behaviours. Aim To explore how a prescription chart structures the task of prescribing insulin. Methods Qualitative study involving interviews with seven jun- ior doctors who routinely prescribe insulin for children.Interviews comprised two phases: ‘free association’ interview where doctors described their approach to insulin prescribing; and a simulated prescribing task using think-aloud methodol- ogy, where doctors verbalised their reasoning while completing an insulin prescription chart. Interview transcripts were the- matically analysed, guided by a published insulin prescribing framework. Doctors’ approaches during each interview phase were compared, supported by content analysis of coded data. Results Introducing a simulated scenario and prescription chart caused doctors to shift from a holistic to a narrower, task-focused approach to prescribing. Fewer doctors verbalised an intention to interact with patients. Despite having the chart as a prompt, they were less likely to mention checking aspects of their prescriptions. Doctors did not reflect on their own ability to prescribe in either the free association or simulated prescribing phase. Conclusion This study shows that the use of a prescribing sce- nario and prescription chart changes doctors’ behaviours. Training doctors to prescribe by completing charts alone may de-emphasise the importance of patient engagement. We rec- ommend patient-centred prescribing education for medical stu- dents and doctors, involving a staged progression from prescribing in classroom settings, to prescribing with simulated patients, to opportunities to prescribe in practice under super- vision. Doctors should be encouraged to reflect on their own abilities while prescribing.
Original languageEnglish
Article numberG628(P)
Pages (from-to)A254-A255
Number of pages2
JournalArchives of Disease in Childhood
Volume104
Issue number(Suppl2)
DOIs
Publication statusPublished - 2019

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