Formalized prescribing error feedback from hospital pharmacists: doctors' attitudes and opinions

Abstract

Doctors have reported a lack of awareness of their prescribing errors with lack of feedback considered a system failure. This article summarizes the views of hospital doctors about receiving formal prescribing error feedback from ward-based pharmacists.

Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis

“… Neonatal Intensive Care Unit Doctor/physician: 42 Nurse: 33 Midwife: 2 170 (77 Australians and 93 Polish) Surveys Mixed-methods Minor concern Lee et al 2016 39 South Korea To explore the need for pharmaceutical care services, key features of desirable pharmacy services, and perceived barriers for advancing the services in hospital environments with doctors and nurses who are key co-workers of the interdisciplinary team care services Medical Doctor/physician: 18 Nurse: 15 33 Interviews Framework analysis No or very minor concern Livori et al 2021 40 Australia To determine whether a cardiology pharmacist consultation undertaken prior to a cardiologist consultation reduced the time spent by the cardiologist gathering medication information, and to assess the cardiologist's experience regarding the presence of a cardiologist pharmacist in the outpatient clinic. Outpatient/ambulatory Doctor/physician: 4 4 Interviews Mixed-methods Serious concern Lloyd, Watmough, and O'Brien 2015 41 United Kingdom To ascertain the views of doctors toward receiving formalized prescribing error feedback, specifically to explore what the impact has been on them as prescribers and their views on pharmacists as facilitators of prescribing error feedback. Medical Doctor/physician: 10 10 Interviews Thematic analysis Minor concern McDaniel et al 2017 42 United States of America Overall: to determine the impact the addition of a second ICU pharmacist covering 30 adult ICU beds at a large regional medical centre has on the complexity of pharmacists' interventions, the types of clinical activities performed by the pharmacists, and the ICU team members' satisfaction Focus group component: to qualitatively describe the additional pharmacists' impact on patient care, team dynamics, and the quality of pharmacy services provided.…”

“… Australia 20 , 40 , 45 , 46 , 50 Canada 53 Indonesia 6 Ireland 44 South Korea 39 USA 5 Malta 21 Portugal 45 Unknown 48 Medication reviews and/or prescribing feedback Activities that involved reviewing the medications prescribed during admission, aimed at identifying any potential medication-related problems and promoting the quality use of medicines. Australia 26 , 45 , 50 Canada 27 Ethiopia 43 , 49 Indonesia 6 Ireland 44 Malta 21 Mexico 29 Pakistan 23 , 37 Qatar 35 Sweden 31 , 33 , 52 Switzerland 25 UK 41 USA 5 , 28 , 34 , 42 Unknown 24 , 48 Proactive roles in medication-related therapy decisions Collaborative activities or discussions between pharmacists and other members of the multidisciplinary team that occurred before prescribing any medications or making therapeutic decisions. Australia 20 , 38 , 45 , …”

“… Australia 20 , 38 , 45 , 50 , 51 Ethiopia 49 India 32 Indonesia 6 Malaysia 19 Malta 21 Pakistan 22 South Korea 39 Qatar 35 Sweden 31 , 33 Switzerland 25 USA 28 , 34 , 42 Unknown 48 Drug information and education for other health professionals Activities that were designed to assist health professionals in obtaining information regarding medications in general or to aid in prescribing e.g., continuing education sessions. Australia 20 , 38 , 45 , 46 Brazil 30 Canada 27 Ethiopia 49 France 36 India 32 Indonesia 6 Malaysia 19 Malta 21 Mexico 29 Pakistan 23 , 37 Portugal 45 , 46 South Korea 39 Qatar 35 Sweden 31 , 33 Switzerland 25 UK 41 USA 28 , ...…”

“…Doctors and nurses also mentioned negative impacts on their workload and the quality of collaborative relationships with hospital pharmacists due to limitations in current pharmacy service models provided in each country or each specific hospital (Low Confidence), 6 , 20 , 26 , 29 , 32 , 33 , 35 , 41 , 43 , 45 , 47 and that current pharmacy services in some regions are unsustainable or inefficient in general (Low Confidence). 6 , 37 , 41 , 44 In one Australian study, one nurse shared while reflecting on practice with a unit-based versus ward-based pharmacist, “It was better with a ward pharmacist but now we as nurses have to find time to chase drs [doctors] and pharmacists to change doses to order new medications and also for microapproval numbers.”, indicating that the new unit-based model created additional time pressures as the pharmacist was not always readily accessible. 26 …”

Implementation and evaluation of a good prescribing tip email to reduce junior doctors' prescribing errors

“…5 A common theme in studies of doctors' attitudes towards error causation is receiving insufficient feedback about their prescribing which creates a barrier to learning and changing prescribing behaviours. [6][7][8][9] A large, multi-centre investigation into the causes of junior doctors prescribing errors (EQUIP study) recommended that trainees receive effective feedback on their prescribing performance and that interventions to improve prescribing practice and patient safety should be explored. 6 Audit and feedback has been extensively investigated as a tool to improve healthcare professionals' behaviour and patient outcomes.…”