The Dose-reference Card (“Dr CARD”)

Example from Imperial College Healthcare NHS TrustPublished
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Summary of the example

Junior doctors do most inpatient prescribing, with a relatively high error rate, and locally had reported finding prescribing very stressful. We developed an intervention to improve Foundation Year 1 (FY1)
doctors’ experience of prescribing, and evaluated their satisfaction with the intervention and perceptions of its impact.

FY1 doctors reported feeling stressed and time pressured when prescribing; this was perceived to contribute to error. A plastic credit-card sized card presenting common drugs and doses was well-received, perceived to be useful, and recommended for on-going use.

Why we think it’s important

Prescribing errors occur in up to 15% of medication orders in UK hospitals. Interventions are therefore needed. There are many reasons why newly qualified Foundation Year 1 (FY1) doctors are a suitable target for such interventions.

First, FY1 doctors do most of the prescribing in the UK hospital inpatient setting. Second, while there is variation in reported junior doctors’ prescribing error rates, FY1 doctors are reported to have a prescribing error rate twice that of consultants. Third, they are more readily accessible as a group than their senior counterparts. Fourth, good prescribing habits learnt early will hopefully be retained throughout a doctor’s career. Finally, FY1 doctors report lower confidence in their prescribing skills than FY2 doctors; identify that lack of knowledge of prescribing contributes to errors; and locally, find prescribing very stressful with concerns about errors.

We also identified that FY1 doctors were often carrying handwritten lists of drugs and doses, which were not necessarily up to date or in line with the local formulary. We therefore wanted to develop and evaluate an intervention to address these issues.

Learn more about the example

Aims and objectives of the work

To develop and evaluate an intervention to improve FY1 doctors’ experience of prescribing in our organisation.


Based on findings of a focus group and questionnaire, we developed a plastic credit-card sized Dose Reference Card (‘‘Dr-Card’’) for use at the point of prescribing. This summarised common drugs and dosing schedules, was in line with the hospital formulary and approved at the Drugs and Therapeutics Committee, and was distributed to all new FY1 doctors in a London teaching trust. A post-intervention questionnaire explored satisfaction and perceived impact (see published paper – details below).

Key findings

Focus group participants (n = 12) described feeling anxious and time pressured when prescribing; a quick
reference resource for commonly prescribed drug doses was suggested. Responses to the exploratory questionnaire reinforced these findings.

Following Dr-Card distribution, the post-intervention questionnaire revealed that 29/38 (76 %) doctors were still using it 2 months after distribution and 38/38 (100 %) would recommend ongoing production. A total of 20 (91%) of 22 respondents who answered the question “Will the Dr-Card improve patient safety” indicated “yes”. Collecting specific data on how often users actually used the card and prevented a prescribing error would be ideal but is currently not feasible within existing resources.

No unintended consequences were identified. Cards have a review date of one year to discourage use more than one year after issue, to avoid use of out of date cards.

The card has since been produced annually in our organisation and is well received. An evaluation in the Spring of 2019 confirmed that FY1 doctors still found it useful following the change to electronic prescribing within our organisation.


See attached example of Dr-CARD in the link below




National guidance, data and publications

Published paper: Reynolds M, Larsson E, Hewitt R, Garfield S, Franklin BD. Development and evaluation of a pocket card to support prescribing by junior doctors in an English hospital. International Journal of Clinical Pharmacy 37: 762-766.

Open access paper – link provided below: