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Joint working: EPIFFANY - Preparation for National Upscale

Joint Working Project between University of Leicester (UoL), East Midlands Academic Health Science Network (EMAHSN) and Pfizer Ltd.

 

Background:

The National Patient Safety Agency (NPSA) estimates avoidable harm from medicines costs the NHS more than £750 million each year in England (NPSA, 2007)1. In light of this, reducing the burden of medication errors is paramount for improving patient safety and reducing this avoidable cost to the NHS. Junior doctors are intimately involved in the medication decision-making process as patients enter hospital as well as in the monitoring of medicines during the inpatient stay and on discharge from hospital. The EQUIP study2, commissioned by the General Medical Council (GMC) to investigate the contribution of junior doctors to medication errors, found junior doctors, in their first and second years in practice, to make twice as many errors in prescribing as consultants, nurses or pharmacists.

The EPIFFANY (Effective Performance Insight for the Future) intervention is a multifaceted complex educational approach for improving prescribing competence, performance and attitudes towards safe prescribing and patient care among junior doctors; to increase patient safety and reduce human error.

Through a number of formal agreements with Pfizer Ltd, (A. Pilot EPIFFANY project funded as a Medical and Educational Goods and Services in 2013/14, B. Joint Working collaboration to develop branding templates and other materials in 2014/15 and C. EPIFFANY Toolkit development funded and project managed as a Medical and Educational Goods and Services in 2016/17) the EPIFFANY programme was developed across three sites: University Hospitals of Leicester (UHL) NHS Trust General Hospital, John Walls Renal Unit and the United Lincolnshire Hospitals (ULH) NHS Trust Boston (Pilgrim Hospital in the General Surgery and Orthopaedic specialties).

It was reported by UHL that the increase in prescribing competence at the hospital using the EPIFFANY educational approach translated to a 50% reduction in prescribing errors, equating to a 100% improvement in prescribing performance of junior doctors who received the education, with a potential cost avoided estimated to be £308,928 and a potential of 489 bed days avoided3.

To support successful national dissemination, evaluation is now required to demonstrate that EPIFFANY could be effective in different settings together with testing and evaluating a model for spread both across a region and across a trust. This joint working project aims to evaluate each of these things. This joint working project also provides a good opportunity to evaluate an EPIFFANY toolkit previously developed to support national dissemination supported by Pfizer Ltd by providing funding and project management through a Medical and Educational Goods and Services.

 

Project:

The aim of this joint working project is to support the sustainable dissemination and adoption of EPIFFANY nationally in three ways:

  1. Evaluate the effectiveness of EPIFFANY in three further sites and specialities in the East Midlands distinct from those to date.
  2. Evaluate the effectiveness of EPIFFANY when implemented outside of the East Midlands and across a whole site using a light touch approach.
  3. Evaluate the EPIFFANY toolkit and identify ways in which the toolkit can be improved to ensure it meets its objective of providing enough information for a local EPIFFANY project team to be created and effectively implement the EPIFFANY intervention.

 

Outcomes:

Benefits of this project include:

Benefits to Patients
  • Reducing prescribing errors may improve patient safety by preventing avoidable harm and adverse events
  • Improved patient satisfaction and confidence
Benefits to the NHS
  • A reduction in prescribing errors means there will be cost savings to the NHS in terms of staff time and the procurement of medicines.
  • Junior doctors taking part in the intervention should have increased levels of confidence in prescribing and preparedness for practice in a clinical setting. This will be measured using qualitative methods
  • Junior doctors will have overall better performance, not just in prescribing but in being able to identify errors and improvements in treating patients as a result of educator feedback
  • There will be a cost-avoidance for the Trust associated with a reduction in both the number and severity of prescribing errors.
  • Rich data sets will be gathered which can be used for wider scale comparison for example number of errors from FY1 doctors compared to consultant and FY2 doctors as well as comparisons on severity of errors.
Benefits to EMAHSN
  • Evaluation will demonstrate the feasibility of the potential for adopt and spread.
  • Project will demonstrate collective partnership approach as a model for adopt and spread.
Benefits to Pfizer
  • Improved reputation as a result of working effectively with an innovative project which promotes good practice and benefits the patient outcomes and experience nationally

 

References

  1. National Patient Safety Agency. 2007. Safety in doses PSO Report. Available from: http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61392 . [Accessed 08/08/16]
  2. Dornan, T., Ashcroft, D., Heathfield, H., Lewis, P., Miles, J., Taylor, D., Tully, M. and Wass, V., 2009. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. London: General Medical Council, pp.1-215.
  3. Results from University Hospitals of Leicester NHS Trust, John Walls Renal Unit - Data on File at UHL
PP-PFE-GBR-0668 / Sept 2017