Intern prescribing decisions: few and far between.

OBJECTIVE

To examine the scope of intern prescribing practices by determining: the proportion of prescriptions that interns chart compared with other medical staff; the proportion of intern-charted prescriptions for which interns are sole decision-makers; whether or not intern-initiated prescribing varies with respect to the specialty to which they are attached, the shifts they are working and the types of charts they are using; the types of clinical conditions for which interns initiate prescribing decisions; and the drug classes that interns use for their self-initiated prescribing.

METHODS

Prospective study of a random sample of intern-charted prescriptions.

METHODS

Two teaching hospitals of the Hunter Area Health Service, Newcastle, Australia. The study was conducted from the fifth to the eighth month of the intern training year.

METHODS

The proportion of prescriptions charted by interns that resulted from their own decision-making, the circumstances relating to this, clinical conditions for which they prescribe and drugs prescribed.

RESULTS

A total of 17,895 prescriptions were examined--3437 (19%) were intern-charted. Interns reported they were the sole decision-makers for 19% (95% CI: 14 -24%) of prescriptions they had charted. Interns were more likely to initiate decisions in accident and emergency (OR=7.5, 95% CI: 2.2- 25.2) and obstetric and gynaecology (OR=2.3, 95% CI: 1.6 -3.2) rotations than in medicine and were more likely to initiate decisions on night (OR=7.3, 95% CI: 3.4- 15.5) and weekend (OR=1.7, 95% CI: 1.0 -3.2) shifts than during the day. They were also more likely to prescribe on the "as required" (OR=36.6, 95% CI: 20.6-65.0), "statim" (OR=26.1, 95% CI: 17.0- 40.1) and "intravenous" (OR=7.2, 95% CI: 4.3-12.3) charts compared with "regular" charts. A total of 52% of intern-initiated prescriptions were for symptom relief; pain, insomnia and nausea; and 75% of the drugs for which interns made independent decisions were analgesics, antithrombotic agents, psycholeptics, antispasmodics, laxatives and anti-asthmatic agents.

CONCLUSIONS

Interns have a limited role with respect to independent prescribing and take the sole responsibility for only one-fifth of the prescriptions they chart. This limited, albeit safe, approach to prescribing may impact significantly on an intern's opportunity to acquire the skills necessary to become an independent, rational prescriber.