The Dose Reference Card (Dr-Card)

Project summary

Background

Junior doctors do most inpatient prescribing in the UK hospital setting, and research shows that error rates are relatively high among the prescriptions written. Exploring this issue with junior doctors in North West London,  they reported finding prescribing very stressful.

We therefore wanted to create an intervention to improve foundation year 1 doctors’ experience of prescribing, and then evaluate their satisfaction with the intervention and perceptions of its impact. The intervention was the Dose Reference Card (“Dr-Card”) which was printed on credit-card sized laminated cardboard and designed to be carried within hospital identification badge holders or pockets. The card was designed to be a quick reference when access to more detailed information is not available, such as when the doctor is away from a computer or British National Formulary.  

The Dr-Card includes the name, dose, and route of commonly prescribed adult inpatient drugs in the local formulary. These include analgesics, antihistamines and anti-emetics as well as summaries of the insulin sliding scale and warfarin initiation protocols.

The evaluation covered 82 Foundation Year 1 doctors across three hospital sites within Imperial College Healthcare NHS Trust.

Outcomes

• Following distribution of the initial Dr-Card in August 2013, a post-intervention questionnaire revealed that 30/41 (73%) respondent doctors were still using it two months after distribution and 38/38 (100%) would recommend ongoing production. 
• Based on the evaluation, and incorporating suggestions from the questionnaire, an updated Dr-Card was produced for subsequent intakes of junior doctors, presented as a more robust plastic card. The information was also incorporated into a local smartphone application for junior doctors. Drugs and doses are reviewed annually by clinical pharmacists, junior doctors and specialists, to ensure that they remain aligned with local practice and relevant guidelines.

Outputs

Reynolds M, Larsson E, Hewitt R, Garfield S, Dean Franklin B. Development and evaluation of a pocket card to support prescribing by junior doctors in an English hospital. International Journal of Clinical Pharmacy.  October 2015, Volume 37, Issue 5, pp 762-766.