{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T18:10:01Z","timestamp":1756663801510,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Improv Report"],"accepted":{"date-parts":[[2016,3,24]]},"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p>Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways.<\/jats:p>\n               <jats:p>We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines.<\/jats:p>\n               <jats:p>Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper\/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC \u201cusability\u201d. To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12).<\/jats:p>\n               <jats:p>The EPCs were well received (80% quite\/very useful) and found \u201ceasy to use\u201d (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route \/ additional required information (pre-intervention 75%, post-intervention 97.7%).<\/jats:p>\n               <jats:p>The EPCs support the management of unwell patients, are relevant to the workload of modern doctors practice and may improve patient care. This improvement measure could be applied to other NHS trusts and medical specialties.<\/jats:p>","DOI":"10.1136\/bmjquality.u204172.w4017","type":"journal-article","created":{"date-parts":[[2016,4,5]],"date-time":"2016-04-05T22:03:15Z","timestamp":1459893795000},"page":"u204172.w4017","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Improving acute medical management: Junior Doctor Emergency Prescription Cards"],"prefix":"10.1136","volume":"5","author":[{"given":"Joe","family":"Hutton","sequence":"first","affiliation":[{"name":"Gloucestershire NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Gingell","sequence":"additional","affiliation":[{"name":"Gloucestershire NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Gloucestershire NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,4,5]]},"reference":[{"key":"2025083110452109000_5.1.u204172.w4017.1","doi-asserted-by":"publisher","DOI":"10.1080\/01421590701310897"},{"issue":"(3)","key":"2025083110452109000_5.1.u204172.w4017.2","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/tct.12127","article-title":"Can new doctors be prepared for practice? A review","volume":"11","author":"Cameron","year":"2014","journal-title":"The clinical teacher"},{"key":"2025083110452109000_5.1.u204172.w4017.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2923.2009.03604.x"},{"issue":"(3)","key":"2025083110452109000_5.1.u204172.w4017.4","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/13576280400002510","article-title":"Junior doctors' opinions about the transition from medical school to clinical practice: A change of environment","volume":"17","author":"Prince","year":"2004","journal-title":"Education for Health"},{"issue":"(5)","key":"2025083110452109000_5.1.u204172.w4017.5","first-page":"1098","article-title":"An audit of adherence to guideline based post-operative paediatric prescriptions in a district general hospital","volume":"37","year":"2012","journal-title":"Regional Anesthesia and Pain Medicine"},{"key":"2025083110452109000_5.1.u204172.w4017.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520230061039"},{"key":"2025083110452109000_5.1.u204172.w4017.7","unstructured":"Dorman T , Ashcroft D , Heathfield H , Lewis P , Miles J , Taylor D , Tully M , Wass V . An in depth investigation in causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. General Medical Council 2009."},{"key":"2025083110452109000_5.1.u204172.w4017.8","doi-asserted-by":"publisher","DOI":"10.1518\/155723405783703019"},{"issue":"(2)","key":"2025083110452109000_5.1.u204172.w4017.9","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.socscimed.2009.10.016","article-title":"Do guidelines create uniformity in medical practice?","volume":"70","author":"Jong","year":"2010","journal-title":"Social Science & Medicine"},{"issue":"(9188)","key":"2025083110452109000_5.1.u204172.w4017.10","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0140-6736(99)02171-6","article-title":"Practice guidelines developed by speciality societies: the need for a critical appraisal","volume":"355","author":"Grilli","year":"2000","journal-title":"The Lancet"},{"key":"2025083110452109000_5.1.u204172.w4017.11","doi-asserted-by":"publisher","DOI":"10.3310\/hta7050"},{"key":"2025083110452109000_5.1.u204172.w4017.12","unstructured":"Gloucestershire Hospitals NHS Foundation Trust. 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Tomorrow's Doctors: Outcomes and standards for undergraduate medical education [internet] 2009 [cited 2015 July] Available at URL: http:\/\/www.gmc-uk.org\/Tomorrow_s_Doctors_1214.pdf_48905759.pdf"},{"key":"2025083110452109000_5.1.u204172.w4017.14","doi-asserted-by":"publisher","DOI":"10.1002\/msj.20127"},{"key":"2025083110452109000_5.1.u204172.w4017.15","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-3064"},{"key":"2025083110452109000_5.1.u204172.w4017.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2004.00434.x"},{"key":"2025083110452109000_5.1.u204172.w4017.17","doi-asserted-by":"crossref","unstructured":"Lenz H , Pascual R , Miller D , Haponik E . Evaluating resident learning behavior in the medical ICU with distribution of a pocket reference card and confidence survey. American Thoracic Society International Conference 2010.","DOI":"10.1164\/ajrccm-conference.2010.181.1_MeetingAbstracts.A4304"}],"container-title":["BMJ Quality Improvement Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjquality.u204172.w4017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:45:29Z","timestamp":1756662329000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjquality.u204172.w4017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,4,5]]},"published-print":{"date-parts":[[2016]]}},"alternative-id":["10.1136\/bmjquality.u204172.w4017"],"URL":"https:\/\/doi.org\/10.1136\/bmjquality.u204172.w4017","relation":{},"ISSN":["2050-1315"],"issn-type":[{"type":"electronic","value":"2050-1315"}],"subject":[],"published":{"date-parts":[[2016]]}}}