Thursday, April 12, 2018

Evaluation of an Order and Prescription-Entry Curriculum

Meredith Carter
Inova Children's Hospital

Context: New resident physicians (interns) begin residency with variable skills, including their ability to enter orders and prescriptions without direct supervision.

Objectives: The objectives of this study were two-fold. First, the study evaluated the effectiveness of an order- and prescription-entry curriculum. Second, the study assessed changes in intern confidence writing orders and prescriptions as a result of this curriculum.

Design: Single group pretest-posttest study during a 2-week pediatric intern orientation in June 2017. Setting: Medium-size pediatric residency program sponsored by an independent academic medical center. Participants: Residents entering the Inova pediatric residency program in June 2017 (n=13). Intervention: 6.5-hour order- and prescription-entry curriculum during intern clinical orientation prior to the start of clinical duties. Main outcome measures: For the first study objective, the primary outcome was the change in the number of interns who were entrustable to complete each of the three order-writing tasks (admission orders, inpatient medication orders, outpatient prescriptions) without direct supervision from pre-curriculum to post-curriculum. For the second objective, the primary outcome was the change in intern confidence on a 5-point Likert scale from pre-curriculum to post-curriculum. 

Results: At the beginning of orientation, none of the interns was entrustable to enter admission or inpatient medication orders and only 3 (23%) were entrustable to complete outpatient prescriptions without direct supervision. Following the curriculum, 9 (69%) were entrustable for admission orders and outpatient prescriptions, and all were entrustable for inpatient medication orders. Intern confidence levels increased from a median of 2 to a median of 4.

Conclusions: New pediatric interns are not prepared to enter orders and prescriptions without direct supervision at the start of residency, but a brief curriculum is effective in preparing them for and increasing their confidence in these skills.