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Yeah. Right. So we've got a fair bit to get through this evening and thank you all so much again for joining. Um, so I'll just crack on as it's hit seven o'clock. Now. Um, can everyone see my slides? All right. As I've had a few incidents in the past with that. If he just popped something in the chat fab. Yes. Can see your title slide. Lovely. If there's any tech issues at all during this, just pop something in the chart and I'll do my best to sort it. I'm not a tech wizard by any means, but, um, I'll do what I can to sort out my wifi. Um, so thank you all again. Um This is, I think now probably the 12th or 13th talk, I think. Now in our Hello, it's the fy one series for Mind the Bleep. My name is Ramya. Um I'm one of the fy one cos for mind the Bleep, um, along with Manish and Viv who are pictured there. Um, and we're part of a wider team of Deanery reps. Um, who you guys may know from your whatsapp group chats. Um This is a series called Hello, it's the fy one. It's a national webinar series to help you through your on calls as an fy one, hopefully with a range of speakers, giving you some advice that we hope will be helpful as you go through your out of hours shifts. Um, the talks generally run on Tuesday evenings from 7 to 8 pm like today. Um, there are a few of our talks that are rescheduled to a Monday, for example. Um But we always make that really clear in the event descriptions and it was aimed at fy one doctors. So our usual disclaimers, all of our mind, the bleep content is intended only to be viewed by healthcare professionals. We have anonymized all clinical cases. Um Any resemblance to actual people is unintentional. Um And our team, we will always try to make sure that the information provided in our content is accurate. Um Obviously, we're all professionals um and independent learners and doctors. And so we do remind you that um that it's sort of our responsibility. It's your responsibility to keep up to date with any new information medicine is always evolving so things can be out of date within a matter of days. Um Sometimes and for our full disclaimers, um please see the link below. I can see someone's um mentioned in the chat. Will this be recorded? Yes, it will be recorded. Um And we will be posting this recording to me as catch up content and hopefully to youtube as well. Um In the longer term, hope that helps. So if you want any further resources, um we have whatsapp groups um for each Deanery. So if you scan that QR code in front of you, now, um you should be taken to a link for all the mind, the Bleep whatsapp groups. Um They're a good way of finding out what talks are coming up in the future. I'd recommend highly, highly recommend you give us a follow on medal. Um That's the easiest way of just seeing all of our upcoming sessions. Um And there's of course, the mind the bleep website, um that has a range of articles, really helpful articles including loads of articles on prescribing, which is today's topic. So I would really recommend that you go and have a look at those after the session. So with all of that out of the way, um, let's crack on. So our topic today is, um, prescribing tips for on calls. Um, I'm Ramya, I'm an F two in the Northern Deanery. And our learning objectives for tonight. Are we are gonna talk through some strategies to decrease risk of medication error when prescribing on your on call shifts will improve our confidence and fluid prescribing, especially when it comes to maintenance fluids. Um We'll develop a strategy um for prescribing medications for symptom, control, things like analgesia and antiemetics in particular. Um And we'll build our confidence in prescribing critical medications, things like Parkinson's medications, um Antiepileptics, antibiotics, for example. And we'll also provide you with some knowledge of resources that are available to you to help with your prescribing whilst on call. So this is obviously a massive topic. It would be impossible to cover how to prescribe every drug ever during one single one hour talk. So, what I've tried to do here is just pull together some strategies, try and make things interactive at times. Um, prescribing is not always the most exciting sort of case based session. Um But I have tried to make it interactive. Um So bear with me with that and I'd really appreciate if you did interact with those bits. So I thought it would be helpful to start off with some stats from the GMC. Um So I know as an F one when I started prescribing was one of the things that did worry me the most and especially prescribing on a high pressure shift. Um So something that reassured me, actually, when I read through this GMC survey, um is that F one doctors make about the same number of errors as their seniors. So there's a sort of fairly steady error rate of 8 to 10% prescriptions across most grades of doctors, these errors however can be serious. So in about 5% of cases and potentially lethal in about 1 to 2% of cases. Unsurprisingly, the most commonly prescribed drugs have the highest error rate of prescriptions and the most common errors that we see in prescriptions are omissions. So just leaving out, for example, when you're clocking someone in leaving out one of their medications at that point from their drug chart, incorrect dosing, so too high or too low or the wrong timings, for example, um, and duplication of prescriptions so that I suppose can be dangerous in case of duplication of giving that drug to the patient as well. So, in bearing all of that in mind, I thought what can be a strategy that we can work through together to try and minimize our prescribing errors when we're on a high pressure shift. And these are the things that I came up with. So first a sort of check in of how am I feeling next? How urgent is this prescription actually? And do I need some help and then reviewing allergies, weight drug chart, renal and hepatic function and then thinking about route of administration. So these all it sounds really, really basic, but I thought it would be useful to just run through something like this um which you can fall back on when you're feeling really tired on those long shifts. That sort of brings me on nicely to the first point of how am I feeling? How urgent is this? Do I need help? So being aware of your own stress levels and workload is really important on long course shift. Um If you are tired, if you're hungry if something's gone wrong and you're angry about it, that can all affect your prescribing essentially. Um, so the little H pneumonic is quite useful for that. So that's hungry, angry, lonely, I suppose that that sort of fits in with if you need some help, potentially. Um, so are you lonely in that you, you need somebody else to run this by on an on call shift or are you tired? Um, and all of those things will increase your risk of making a medication error on a busy on call shift. Um And that's why looking after your wellbeing is the most important thing. So if you find yourself in any of those situations, do something about it. So if you're hungry, go and grab a bite to eat, take a breath, just take a, a proper break as well if you've not had one and that fits in with. How urgent is this prescription? Does it need to be done right now? Is this a very, very time critical prescription or can it wait until I've gone and had a bite to eat? And I'm gonna be a lot more useful to everyone in that way. Um The other thing to think about is whether this is a safer decision in hours rather than out of hours. So making a big medication change, for example, um for example, changing someone's antiepileptics that shouldn't, in most cases be a decision for out of hours that should be discussing with neurology in hours and making those changes. Um So just consider whether this is something that needs to be run by a pharmacist or run by a specialist before you make that medication change. So, is it better to just wait until in hours? Obviously, if it's not safe to do that, if it is time critical, then it does need to be done. Now, um, similarly, if this is an unfamiliar drug or an unfamiliar route of giving a drug, um think, do I need help actually, do I need to run this by a senior? Do I need to run this by an on call pharmacist potentially? Um So that can be also just a useful thing to run through in your head. And we have had some quite interesting talks as part of this series on wellbeing and night shifts. So last week's talk was on night shifts.