Objectives and Background Our emergency department (ED) receives a new cohort of junior doctors every 6 months as part of the national manpower allocation to meet health service needs. Prescribing errors by these doctors tend to be higher at the beginning of their postings followed by some improvement as they adapt to the work in ED but the magnitude and the direction of this change for each cohort has not been consistent. In an attempt to address this problem, an approach involving the use of metrics to drive individual performances through monthly plan-do-check-act cycles was implemented in May 2009. The monthly tally of prescribing errors became one of the key performance indicators for the junior doctors.
Methodology Monthly broadcasting of prescribing error counts by each doctor allows them to benchmark individual performances against one another and provides a reference for self-improvement for the following month. The monthly tally of prescribing errors are also computed into a pre-determined formula and translated into their monthly social fund as incentive for the whole cohort to keep the prescription errors as low as possible. A control chart of the monthly tally was plotted based on a total of 48 data points for 8 cohorts over 4 years from May 2007 to April 2011 to monitor the impact of the intervention.
Results The monthly tally showed a shift towards fewer counts of prescribing errors in the post-intervention phase, with a mean of 29 (upper control limit 45, lower control limit 13) among the pre-intervention cohorts compared to a mean of 18 (upper control limit 31, lower control limit 6) among the post-intervention cohorts.
Conclusion The use of metrics has helped to drive and sustain a reduction in prescribing errors among junior doctors as a cohort during their 6-month postings in our ED.
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