IntroductionFew studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers' perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks. MethodsWe studied a large hospital using inpatient EP. From April to June 2016, semi-structured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers' perceived causes of the error and views about EP, and were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason's accident causation model, with a focus on identifying latent conditions. ResultsTwenty-five interviews explored causes of thirty-two errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP.There were three broad groups of latent conditions: the EP system's functionality and design; the organisation's decisions around EP implementation and use; and prescribing behaviours in the context of EP. ConclusionsErrors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified.

Most studies evaluating the impact of electronic prescribing on prescribing safety have used comparatively weak study designs such as uncontrolled before-and-after studies. This study aimed to apply a more robust naturalistic stepped wedge study design to compare the prevalence and types of prescribing errors for electronic prescribing and paper prescribing. Data were collected weekly during a phased electronic prescribing implementation across 20 wards in a large English hospital. We identified 511 (7.8%) erroneous orders in 6523 paper medication orders, and 312 (6.0%) in 5237 electronic prescribing orders. Logistic regression suggested no statistically significant effect of electronic prescribing use or of study week; patient and ward had significant effects. Errors involving incorrect doses and illegible or incomplete orders were less common with electronic prescribing; those involving duplication, omission, incorrect drug and incorrect formulation were more common. Actions are needed to mitigate these error types; future studies should give more consideration to the effects of patient and ward.

Objectives: Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)'s third Global Patient Safety Challenge were being addressed in a sample of hospital organisations.Methods: A qualitative approach was taken using a combination of focus groups, semistructured interviews and documentary analysis in four UK teaching hospital organisations. A purposive sampling strategy was adopted with the aim of recruiting healthcare professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organisations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organisations to identify interventions recently implemented, those currently being implemented and plans for the future. A content analysis was undertaken, using the WHO's third Global Patient Safety Challenge priority areas and domains as deductive themes.Results: All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all four sites. However, a greater number of interventions focused on 'healthcare professionals' and 'systems and practices of medicines management' than on 'patients and the public'. In terms of the priority areas, the main focus was on 'high risk situations', particularly high-risk medicines, with fewer interventions in the areas of 'transitions of care' and 'polypharmacy'.Conclusions: More work may be needed to address patient and public involvement in medication safety and the priority areas of 'transitions of care' and 'polypharmacy'.Comparative global studies would help build an international picture and allow shared learning.