Prescribing in Teaching Hospitals: a Qualitative Study of Social and Cultural Dynamics

Abstract

Background: General practitioners integrate an array of social and environmental factors into their prescribing decisions. In teaching hospitals, despite the involvement of multiple practitioners in making and acting on prescribing decisions, little is known about the influence of roles, relationships, professional subcultures and underlying beliefs, on prescribing practices. Aim: To explore the social and cultural dynamics of prescribing in teaching hospitals. Method: Consultants, registrars, junior doctors, nurses and pharmacists from 2 large Sydney teaching hospitals were sampled purposively and invited to participate in a qualitative study involving semi-structured interviews. The interview topics explored included: attitudes about prescribing, roles and responsibilities, communication of decisions, influences on prescribing and factors contributing to prescribing errors. Interviews were transcribed verbatim and the content analysed thematically. Results: Participants included 8 consultants, 8 registrars, 9 junior doctors, 7 nurses and 11 pharmacists. 5 distinct sets of social and cultural influences on prescribing behaviours were identified. The dominant set of influences related to the structure of how prescribing took place and chief among these were the strong intra-professional relationships of medical teams. Other social and cultural influences related to how prescribing decisions were communicated, underlying assumptions within medical teams, knowledge acquisition and the hospital environment. Conclusion: Prescribing in teaching hospitals is shaped by a complex web of social and cultural dynamics. An appreciation of these influences may be vital to the success of strategies to improve use of medicines in teaching hospitals. J Pharm Pract Res 2008; 38: 286-91.

Which non‐technical skills do junior doctors require to prescribe safely? A systematic review

“…Fourteen studies (from the UK , USA and Australia ) were included in the final analysis (Figure ). All bar one were qualitative or mixed methods research.…”

“…Failures of situational awareness were associated with prescribing errors in 13 of the reviewed papers .…”

“…Studies reported junior doctors failing to understand the limits of their experience, knowledge and skills, leading to errors such as failure to look up drug doses or access other vital information .…”

“…Nine studies described suboptimal environments and conditions for prescribing, with distractions, interruptions and noise as well as hunger and stress affecting performance . Junior doctors were able to recognize the contribution of these circumstances in retrospect, but had usually missed them at the time.…”

“…Many studies noted errors that could have been avoided by acquiring more information before writing the prescription. Failure to check medical history, allergy status, blood test results and potential drug–drug interactions were most common .…”