Prescribing decision making by medical residents on night shifts: A qualitative study.
Introduction: Prescribing of medications with well‐known adverse effects, like antipsychotics or benzodiazepines, during hospitalisation is extremely common despite guideline recommendations against their use. Barriers to optimal prescribing, including perceived pressure from allied health professio...
| Publicado en: | Medical Education Vol. 56; no. 10; pp. 1032 - 1042 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Oct2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=159026403&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 159026403 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03080110 ESF jtl: Medical Education issn: 03080110 maglogo: Y pubinfo: dt: Oct2022 vid: 56 iid: 10 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 159026403 157270617 159026403 159026403 10.1111/medu.14845 159026403 ppf: 1032 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Prescribing decision making by medical residents on night shifts: A qualitative study. aug: au: Lauffenburger, Julie C. Coll, Maxwell D. Kim, Erin Robertson, Ted Oran, Rebecca Haff, Nancy Hanken, Kaitlin Avorn, Jerry Choudhry, Niteesh K. affil: Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Massachusetts,, USA sug: subj: Decision Making, Clinical Internship and Residency Shiftwork Prescriptions, Drug Psychosocial Factors Antipsychotic Agents Therapeutic Use Antianxiety Agents, Benzodiazepine Therapeutic Use Night Care Human Qualitative Studies Semi-Structured Interview Inpatients Stress, Occupational Audiorecording Descriptive Statistics Female White Persons Asians Thematic Analysis Judgment Physicians Nurses Communication Female ab: Introduction: Prescribing of medications with well‐known adverse effects, like antipsychotics or benzodiazepines, during hospitalisation is extremely common despite guideline recommendations against their use. Barriers to optimal prescribing, including perceived pressure from allied health professionals and fatigue, may be particularly pronounced for less experienced medical residents, especially during night shifts when these medications are often prescribed. Under these circumstances, physicians may be more likely to use 'quick', often referred to as System 1 choices, rather than 'considered' System 2 strategies for decisions. Understanding how medical residents use, these different cognitive approaches could help develop interventions to improve prescribing. Methods: To understand decision‐making and contextual contributors that influence suboptimal prescribing during night coverage by medical residents, we conducted semi‐structured qualitative interviews with residents in general medicine inpatient settings. The interviews elicited perspectives on shift routines, stressful situations, factors influencing prescribing decision making and hypothetical measures that could improve prescribing. Interviews were audio‐recorded and transcribed. Data were analysed using codes developed by the team to generate themes using immersion/crystallisation approaches. Results: We conducted interviews with 21 medical residents; 47% were female, 43% were White, and 43% were Asian. We identified five key themes: (i) time pressures affecting prescribing decisions, (ii) fears of judgement by senior physicians and peers and being responsible for patient outcomes, (iii) perceived pressure from nursing staff, amplified by nurses' greater experience, (iv) clinical acuity as a key factor influencing prescribing, and (v) strategies to improve communication between members of the care team, like ensuring adequate hand‐off by day teams. Conclusion: Medical residents highlighted numerous contextual factors that promote quick thinking rather than slower thinking when prescribing on night shifts, particularly time constraints, perceived pressure and patient clinical acuity. Interventions aimed at reducing prescribing should address how to manage stress and perceived pressure in decision making. Medical residents often rely on mental shortcuts when prescribing medications. Interventions are offered for reducing sub‐optimal prescribing by managing stress and perceived pressure. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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