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SCRIPT – an eLearning programme to improve prescribing competence and the safe and effective use of medicines

University of Birmingham, Health Education England and OCB Media Ltd. ·

Summary

Summary of the example

SCRIPT is a web-based eLearning programme used to standardise training and provide continuing professional development relating to prescribing, therapeutics and medicines management. The overarching aim of SCRIPT is to improve therapeutics knowledge, and to reduce medication errors and associated patient harm. Originally commissioned by Health Education England (HEE) in 2010 for Foundation doctors, SCRIPT now provides a portfolio of 123 modules across six versions, spanning the NHS workforce; Foundation doctors (47 modules), Foundation dentists (7 modules), paediatric specialist trainees (24 modules), general practitioners (24 modules), pharmacists, and nurses (21 modules). SCRIPT is integrated into the postgraduate training programme of doctors, paediatric specialist trainees and dentists, with at least six HEE local areas mandating modules. The Medical Schools Council recommend SCRIPT nationally as a remediation tool for Foundation doctors who fail the national Prescribing Safety Assessment [1]. The learning from SCRIPT is relevant to all prescribers and healthcare professionals that administer medicines. Each year, SCRIPT is accessed by more than 20,000 NHS practitioners in England, Wales, and Northern Ireland. SCRIPT is recognised as a solution for improving knowledge about medicines in many national guidance documents and reports [2,3,4,5,6].

Why we think it’s important

There are an estimated 237 million medication errors occurring in England every year [7]. Medication errors can be reduced or prevented on many levels, and influenced by different factors including a lack of therapeutics training, and inadequate drug knowledge and experience [8]. The General Medical Council commissioned studies, PRACtICE [9] and EQUIP[10], which investigated prescribing errors in primary and secondary care respectively, both recommended improved and ongoing training with a focus on practical prescribing and feedback mechanisms.

SCRIPT eLearning provides national training to a range of healthcare professionals in a cost-effective, standardised, and user-friendly environment. The SCRIPT platform provides documented evidence of module completion and a record of knowledge acquisition for registered users. It has been innovated to allow trainers to oversee user progress thus providing a focus for feedback, discussion and reflection about prescribing, application of therapeutic knowledge and medicines management.

SCRIPT has a positive impact on prescribing behaviours in clinical practice, with reports of the learning having prevented prescribing errors [11]. Since medication errors account for 10–20% of all adverse events in the NHS, such changes in prescribing practice through knowledge improvement and increased confidence can have a positive impact on the health and wellbeing of patients.

Learn more about the example

Aims and objectives of the work

The overarching aim of the project was to develop a web-based eLearning programme to support healthcare professionals, particularly those prescribing and administering medicines, to improve and apply their knowledge of prescribing, therapeutics and medicines management, enabling them to deliver safer healthcare for patients.

In order to provide effective prescribing and medicines management education, the project’s objectives are to:

  • Develop modules across a wide range of therapeutic areas, to standardise education and support learning in prescribing, therapeutics and medicines management.
  • Encourage safe, effective, and rational prescribing and use of medicines by ensuring that modules are up-to-date and reflect current NHS practice.
  • Create an engaging and user-friendly eLearning platform that can deliver patient-focused activities, assessment, and audio-visual content which users can easily access for ‘just-in-time’ learning.
  • Create a management site to facilitate supervision of the user’s educational progress which can encourage discussion about prescribing and medicines management in workplace education.
  • Align the content to the curriculum of the user (e.g. UK Foundation Programme Curriculum for Foundation Trainee Doctors).

Utilise the programme to embed lessons learned from serious prescribing and administration errors.

Methodology

Commissioned by Health Education England (West Midlands), the SCRIPT eLearning programme was developed and is maintained by a dedicated editorial team of clinical pharmacists and clinical pharmacologists from the University of Birmingham, together with eLearning specialists from OCB Media Ltd. A scoping exercise with key stakeholders, patient safety incident reports and gap analysis of undergraduate education were used to identify and select module titles and learning outcomes.

Modules are authored, edited and peer reviewed by specialist healthcare professionals. Content includes audio-visual material, formative case studies and activities, and a pre- and post-test to help measure knowledge acquisition. To ensure ongoing accuracy and relevance to practice, module content is reviewed every 2-3 years and updated when required in response to national safety alerts and changes in prescribing practice. The SCRIPT team has continually sought feedback through informal feedback and formal evaluations to adapt the programme. For example, informal feedback is used to regularly re-design the website and amend content. The team can also respond quickly to new requests for module development. For example, the ‘Rheumatology’ module in the ‘Medicine and Surgery’ version of SCRIPT was created at the request of a Foundation school. Importantly, our evaluation has informed how we integrate the learning into postgraduate education. We monitor user interaction with SCRIPT to ensure the intended benefits of the programme are being achieved.

SCRIPT was initially integrated into Foundation training for doctors in the West Midlands in 2011 and has subsequently been adopted by other regions in England, Wales and Northern Ireland. With support from the SCRIPT team, regions can choose to recommend or mandate modules according to their local requirements. The success of SCRIPT for Foundation trainees (Medicine and Surgery SCRIPT) has led to the development of versions for other healthcare professionals.

Key findings

Peer-reviewed studies by the SCRIPT team [12,13] and independent researchers [14] provide evidence to suggest that SCRIPT improves prescribing knowledge and has a positive impact on prescribing behaviours in clinical practice.

Modules completed since 2015:

  • Almost 270,000 for Medicine and Surgery SCRIPT, with over 100,000 of these during 2017/2018.
  • More than 12,000 for Dental SCRIPT.
  • Almost 4,000 for Paediatric SCRIPT.
  • More than 3,400 for Nursing SCRIPT.
  • More than 200 for GP SCRIPT.

Recognition:

  • The SCRIPT programme was shortlisted for the Royal College of Physicians Excellence in Patient Care Awards (Education and Training), 2018.
  • Nursing SCRIPT was highly commended at the West Midlands Academic Health Sciences Network Awards (Patient Safety), 2016.
  • The SCRIPT ‘Dementia Friendly Prescribing’ open access eLearning module for healthcare professionals was a finalist in the Health Service Journal Patient Safety Awards (Education and Training in Patient Safety), 2013.
  • The SCRIPT ‘Dementia-Friendly Prescribing: an open access eLearning module for healthcare professionals’ won the Health Service Journal Patient Safety Awards (Improving Safety in Medicines Management), 2013.

Critical to the success of SCRIPT, has been the support provided to users of the programme. The technical and clinical team have responded to and resolved over 19,000 queries since 2015. Demand for SCRIPT continues to grow and the programme has been licensed to 15 Medical Schools to support their undergraduate teaching. In addition, a pilot version of SCRIPT is currently being trialled for paramedics in training to be non-medical prescribers.

The main risk associated with the SCRIPT eLearning programme is inaccurate content contributing to a medication error. To mitigate this risk, the SCRIPT team have a robust review process in place, the ability to up-date modules quickly, and a disclaimer is clearly written into the Terms and Conditions on the SCRIPT website.

Documents

  • More information about SCRIPT can be found at www.safeprescriber.org/ 
  • Regular updates and information about SCRIPT can be found on our twitter feed @safeprescriber
  • References:
    • listed in the attachment below
  • Publications:
    • Brooks, H.L., et al., An evaluation of UK foundation trainee doctors’ learning behaviours in a technology-enhanced learning environment.
    • Brooks, H.L., et al., Perceptions and Impact of Mandatory eLearning for Foundation Trainee Doctors: A Qualitative Evaluation.
    • Thomas, S., et al., SCRIPT eLearning for Prescribing and Therapeutics: impact on knowledge, skills and patient safety.

Attachments

Links

Background

National guidance, data and publications

SCRIPT is integrated into the postgraduate training of doctors, paediatric specialists and dentists. SCRIPT’s impact on prescribing education is recognised in the national guidance and reports listed below.

  • Healthcare Safety Investigation Branch. Investigation into the inadvertent administration of an oral liquid medicine into a vein. (2019).
  • Health Education England. Combating antimicrobial resistance: Educational approaches for the responsible prescribing of antimicrobials. (2017).
  • Health Education England. Embedding national antimicrobial prescribing and stewardship competences into curricula: A survey of health education institutions. (2016).
  • Health Education England. Prescribing Safety Assessment Guide for Foundation Doctors. (2016).
  • Health Education England. The General Practice Nursing Workforce Development Plan. (2017).
  • National Institute for Health and Care Excellence. Shared Learning Database: Consensus based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education. (2019).
  • Public Health England. Dental Antimicrobial stewardship toolkit. (2016).
  • Royal College of Physicians. Supporting Junior Doctors in Safe Prescribing. (2017).

Links