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M26 Teaching students to prescribe oxygen safely: the impact of an e-Learning module and BTS oxygen prescription section on oxygen prescribing by medical students taking Final MBBS examinations
  1. D Hammersley1,
  2. LJE Smith2,
  3. D Furmedge2,
  4. C Ward1,
  5. S Kennedy1,
  6. LJ Restrick1,
  7. A Sturrock2
  1. 1Department of Respiratory Medicine, Whittington Health, London, England
  2. 2University College London Medical School, London, England

Abstract

Introduction and Objectives National audits show oxygen prescribing is not consistently safe, despite BTS Emergency Oxygen Guidelines. We previouslyidentified that medical students were unable to safely prescribe oxygen at final MBBS examinations.1 A compulsory e-Learning module was introduced to address this unmet educational need. We assessed the impact of this intervention in 2013.

Methods An Oxygen Prescribing Final MBBS OSCE station was used in 2012 and 2013. In 2013 candidates (350) completed a new compulsory oxygen e-Learning module. Candidates in 2012 (227) had not. In 2013 the exam prescription chart also included an oxygen prescription section. Each year, candidates were presented with one of two clinical scenarios. Scenario 1: 72-year-old patient with COPD, and Scenario 2: 72-year-old hypoxic patient without respiratory disease. Oxygen prescriptions were assessed against BTS standards across a number of domains. They were classified as 'safe/unsafe' and 'perfect/imperfect' by a respiratory nurse specialist.

Results Some improvements were seen in both scenarios (See Table 1), particularly prescription of the correct target saturation range. In 2012 40% (42/105) prescribed correct range for the non-COPD scenario; in 2013 this was 98% (154/156).

Conclusions Introducing an oxygen e-Learning module and BTS-recommended oxygen prescription section resulted in improved competence and safety of oxygen prescribing with significant improvement in correct target saturation ranges. However, students still have gaps in equipment knowledge and a high proportion did not prescribe oxygen safely for a patient without respiratory disease. The e-Learning module was undertaken by students at a point close to examinations; moving this earlier in the year may lead to better engagement and improve the understanding of oxygen prescribing in non-COPD patients, emphasised in the module. Safer prescribing is enabled by oxygen prescription sections with target range saturation choices but equipment education is also needed. Adverse consequences of incorrect oxygen use continue to cause patients harm. Ensuring undergraduates have the practical knowledge and skills to prescribe oxygen safely is essential.

Reference

  1. D Hammersley, A Connor, C Ward, et al. Competence in, and safety of, oxygen prescribing by medical students taking Final MBBS as assessed by Objective Structured Clinical Examination. Thorax 2012; 67(Suppl 2):A168

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